Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage*

Arabi, Yaseen M.; Al-Shimemeri, Abdullah; Taher, Saadi

doi:10.1097/01.ccm.0000203947.60552.dd

Cited by 159 publications

(137 citation statements)

References 32 publications

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“…Thus, the admission by day of the week may be less likely to infl uence outcomes in critical care settings, a hypothesis that is supported by prior investigations. [21][22][23] Our study can be compared with prior investigations by Aujesky et al 12 and Bell and Redelmeier. 13 Aujesky et al 12 showed an adjusted OR of 1.17 (95% CI, 1.03-1.34) for mortality from PE on the weekend in a Pennsylvania health-care database from 2000 to 2002.…”

Section: Discussionmentioning

confidence: 49%

Pulmonary Embolism

Nanchal

Kumar

Taneja

et al. 2012

Chest

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Pulmonary embolism (PE) is a common, often fatal, acute medical condition for which timely therapy can be life saving. The average annual incidence of acute PE in the United States is about 110 in 100,000 adults. The case fatality rate in the years prior to the introduction of anticoagulant therapy exceeded 30%; current estimates of case fatality are , 10%. 1,2 The accurate diagnosis of PE relies on clinical acumen and timely use of appropriate diagnostic studies. Indi viduals with PE who present with shock or severe respiratory failure or who have limited cardiopul monary reserve benefi t from prompt use of complex therapies, such as mechanical ventilation, vasopressor infusion, inferior vena cava (IVC) fi lter placement, and thrombolysis.Previous studies of patients admitted with similarly time-sensitive conditions suggested that weekend admission increases the risk of poor outcomes. 3-10 However, the evidence for a weekend effect is not well established for people admitted with PE. Therefore, we carried out the present study to determine whether people admitted with PE on the weekend have worse outcomes than those admitted during the week. To better understand such a phenomenon, we sought to Background: Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time-sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism. Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2000 to 2008 to identify people with a principal discharge diagnosis of pulmonary embolism. We classifi ed admissions as weekend if they occurred between midnight Friday and midnight Sunday. We compared all-cause in-hospital mortality between weekend and weekday admissions and investigated the timing of inferior vena cava (IVC) fi lter placement and thrombolytic infusion as potential explanations for differences in mortality. Results: Unadjusted mortality was higher for weekend admissions than weekday admissions (OR, 1.19; 95% CI, 1.13-1.24). This increase in mortality remained statistically signifi cant after controlling for potential confounding variables (OR, 1.17; 95% CI, 1.11-1.22). Among patients who received an IVC fi lter, a larger proportion of those admitted on a weekday than on the weekend received it on their fi rst hospital day (38% vs 29%, P , .001). The timing of thrombolytic therapy did not differ between weekday and weekend admissions. Conclusions: Weekend admissions for pulmonary embolism were associated with higher mortality than weekday admissions. Our fi nding that IVC fi lter placement occurred later in the hospital course for patients admitted on weekends with pulmonary embolism suggests differences in the timeliness of diagnosis and treatment between weekday and weekend admissions. Regardless of cause, physicians should be aware that weekend admissions for pulmonary embolis...

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Section: Discussionmentioning

confidence: 49%

Pulmonary Embolism

Nanchal

Kumar

Taneja

et al. 2012

Chest

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“…Once a medical hypothesis, the concept of the "weekend effect" has become increasingly examined in the medical literature. 5,7,8,[13][14][15][16][17][18][19] Arguably the most substantial study investigating at the "weekend effect" is the work of Bell and Redelmeier published in 2001. 7 They looked at approximately 3.8 million acute care hospital admissions in Ontario, Canada, over a 10-year period.…”

Section: Discussionmentioning

confidence: 99%

Influence of Weekend Hospital Admission on Short-Term Mortality After Intracerebral Hemorrhage

Crowley

Yeoh

Stukenborg

et al. 2009

Stroke

104

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Background and Purpose— There is expanding literature to show that certain patients admitted during the weekend have worse outcomes than similar patients admitted during the week. Although many clinicians have hypothesized the presence of this “weekend effect” with patients with intracerebral hemorrhage, there is a paucity of studies validating this conjecture. Methods— We performed a retrospective cohort study of patients with intracerebral hemorrhage (International Classification of Diseases, 9th Revision, Clinical Modification=431) extracted from the 2004 Nationwide Inpatient Sample. Multivariable logistic regression analyses and Cox proportional hazards regression were conducted to calculate the odds of death (within 7, 14, and 30 days) and the hazard ratio of death for patients with weekend intracerebral hemorrhage admissions compared with weekday intracerebral hemorrhage admissions. All analyses were adjusted for concurrent differences in length of stay, patient demographics, and comorbid disease. Results— Weekend hospital admissions accounted for 26.8% of the 13 821 patients with a diagnosis of intracerebral hemorrhage in the National Inpatient Sample. Admission during the weekend was a statistically significant independent predictor of death within 7 days (OR, 1.14; 95% CI, 1.05 to 1.25), within 14 days (OR, 1.15; 95% CI, 1.05 to 1.25), and within 30 days (OR, 1.15; 95% CI, 1.05 to 1.25). The adjusted hazard of in-hospital death (hazard ratio, 1.12; CI, 1.05 to 1.20) indicates that the overall risk of in-hospital death with intracerebral hemorrhage is 12% higher with weekend admission. Conclusion— Weekend admission for intracerebral hemorrhage was associated with increased risk-adjusted mortality when compared with admission during the remainder of the week.

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“…In particular, studies that have evaluated round-the-clock 24/7 ICU and trauma staffing found no variability between arrival time and outcomes of care. 11,12 In a recent study of a general medicine service that maintains the same staffing ratio on weekends as that on weekdays, researchers found that night or weekend admission was not associated with worse patient outcomes and suggested that consistent staffing, coordinated handoffs, and rotation schedules that protected against discontinuity may facilitate narrowing the gap in disparity. 13 Moreover, in a study that evaluated policies to improve communication in surgical care, including resident-attending notification regarding routine weekend patient status and weekend patient visits by an attending, results showed significant reductions in potentially harmful communication breakdowns.…”

Section: Innovative Solutionsmentioning

confidence: 99%

Excellent Hospital Care for All: Open and Operating 24/7

Wong

Morra

2011

J GEN INTERN MED

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Nights and weekends are the times when most people are admitted to the hospital. They are also synonymous with reduced staffing levels and fewer specialized diagnostic, procedural, and treatment options. Indeed, there is increasing evidence suggesting that patient care is compromised during these times. Equally important is the inefficient use of capital investments during nights and weekends, and inappropriate utilization of hospital beds caused by poor weekend discharge flexibility. We believe that these findings should be of concern not just to hospital care providers, but across care settings and to the general public. In this perspective article, we highlight how our current office-hours system of running hospitals threatens the lives of our sickest, most vulnerable patients, describe solutions currently implemented in hospitals that may alleviate this disparity, and discuss challenges to wider scale implementation.KEY WORDS: nights and weekend; hospital care; quality and safety; efficiency.

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Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage*

Cited by 159 publications

References 32 publications

Pulmonary Embolism

Pulmonary Embolism

Influence of Weekend Hospital Admission on Short-Term Mortality After Intracerebral Hemorrhage

Excellent Hospital Care for All: Open and Operating 24/7

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