Role of organisational factors on the ‘weekend effect’ in critically ill patients in Brazil: a retrospective cohort analysis

Abstract

IntroductionHigher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients.MethodsWe included 59 614 patients admitted to 78 ICUs participating during 2013. We defined ‘weekend admission’ as any ICU admission from Friday 19:00 until Monday 07:00. We assessed the association between weekend admission with hospital mortality using a mixed logistic regression model controlling for both patient-level (illness severity, age, comorbidities, performance status and admission type) and ICU-level (decrease in nurse/bed ratio on weekend, full-time intensivist coverage, use of checklists on weekends and number of institutional protocols) confounders. We performed secondary analyses in the subgroup of scheduled surgical admissions.ResultsA total of 41 894 patients (70.3%) were admitted on weekdays and 17 720 patients (29.7%) on weekends. In univariable analysis, weekend admitted patients had higher ICU (10.9% vs 9.0%, P<0.001) and hospital (16.5% vs 13.5%, P<0.001) mortality. After adjusting for confounders, weekend admission was not associated with higher hospital mortality (OR 1.05, 95% CI 0.99 to 1.12, P=0.095). However, a ‘weekend effect’ was still observed in scheduled surgical admissions, as well as in ICUs not using checklists during the weekends. For unscheduled admissions, no ‘weekend effect’ was observed regardless of ICU’s characteristics. For scheduled surgical admissions, a ‘weekend effect’ was present only in ICUs with a low number of implemented protocols and those with a reduction in the nurse/bed ratio and not applying checklists during weekends.ConclusionsICU organisational factors, such as decreased nurse-to-patient ratio, absence of checklists and fewer standardised protocols, may explain, in part, increases in mortality in patients admitted to the ICU mortality on weekends.

Evaluation of bed vacancy and occupancy times as governance parameters in patients admitted to a public intensive care unit

“…This finding differs from other studies, in which longer times for processes performed at night and on weekends were observed, explained by fewer staff in those periods. ( 8 - 11 ) However, the of vacancy-to-occupancy time increased when the bed was offered on holidays, in line with the cited studies.…”

The weekend effect for stroke patients admitted to intensive care: A retrospective cohort analysis

“…The effect of weekend admission to ICU for patients suffering severe stroke on in-hospital mortality appears significant for our study population, notably persisting even when adjusting for type of stroke (in contrast to previous studies [7,14]). This outlines the potential effect of in-hospital factors on the 'weekend mortality effect', as alluded to by Zampieri and colleagues [11]. Further, the non-significant higher odds of in-ICU mortality for those admitted over the weekend demonstrates the potential influence of pre-hospital factors on ICU mortality for weekend admissions.…”

“…The present findings underline the particular need for urgent review and management of patients who suffer severe stroke of any kind, where delay may substantially affect outcomes more-so than for other patient sub-populations. Lower numbers of on-site senior staff, lower nurse-to-patient ratios, fewer standardized protocols, and subsequent delays to expert management [11], may have more serious ramifications for severe stroke patients, underlying a sub-population of critically ill patients who need particular care when admitted over the weekend. Our findings are relevant for all healthcare professionals working both in hospital, or on-call from home, responsible for such an at-risk patient population.…”

“…The effect of weekend admission on increased hospital mortality is well described [1][2][3][4][5], but with conflicting consistency across hospitals and specialties [6][7][8][9][10]. In-hospital factors such as lower overnight staffing [11,12], less experienced physicians [13], fewer ward rounds [12], delayed assessment and management [12]-and pre-hospital factors such as sicker patient populations [14] or higher acuity of illness [15], are all posited as potential contributors toward the phenomenon of higher mortality for those admitted to hospital over the weekend (henceforth referred to as the 'weekend effect').…”

Healthcare processes of laboratory tests for the prediction of mortality in the intensive care unit: a retrospective study based on electronic healthcare records in the USA

“…Intensive care unit (ICU) is a hospital ward where critically ill patients are closely monitored, generating a high granularity of data. Several healthcare processes have been analysed in the ICU, such as ICU admission outside daytime hours,7 weekend admission8 9 and the time of discharge 10. However, the healthcare processes of laboratory tests have not been investigated in ICU.…”