Weekend hospitalization and additional risk of death: An analysis of inpatient data

Freemantle, Nick; Richardson, Matthew; Wood, John; Ray, Daniel; Khosla, Sajan; Shahian, David M.; Roche, William R.; Stephens, Ian; Keogh, Bruce; Pagano, Domenico

doi:10.1258/jrsm.2012.120009

Cited by 276 publications

(307 citation statements)

References 11 publications

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“…Again, IHM rate was higher when admission occurred in post-office hours [8] and during the holidays [19] . As for WE versus WD, although a high mortality in subjects admitted during the WE has been reported by several authors, with an estimated increase of risk between 10% and 32% [14,15,[20][21][22] , in our study there was a trend in which more patients admitted during the WE died than those admitted on WD, but this was not confirmed by multivariate analysis. The results reported in the literature are not always consistent when considering the levels of hospital: the prognostic value of WE admission was identified more frequently in major teaching hospitals compared with nonteaching hospitals [23] , but no correlation between WE admission and IHM was found in patients admitted to tertiary care hospitals [24] .…”

Section: Discussioncontrasting

confidence: 87%

In-hospital mortality and length-of-stay in a cohort of ED patients admitted to internistic units

Giorgi¹,

Fabbian²,

Ferro³

et al. 2013

JHA

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Background: Several life-threatening acute diseases exhibit precise preferred times of onset, during the day (morning), the month or season of the year (winter), and the day of the week (Monday). Moreover, admission to the hospital during nighttime and weekend (WE) is associated with increased risk of in-hospital mortality (IHM) and length-of-hospital stay (LOS). Since most of these data have been obtained in North American settings, the aim of this study was to verify also in an Italian setting whether some factors related to ED evaluation, including time of arrival, and disease's severity evaluated by a colour code, could be associated with IHM and LOS in ED patients admitted to internal medicine units. Methods:This study was conducted between January 1, 2010 and July 31, 2012, at the St Anna Hospital of Ferrara. We analyzed age, sex, time of arrival to the ED, ED boarding time, and triage colour code of all patients admitted to the Department of Medicine. Friday to midnight Sunday was considered as WE, and the nine main national festive days were always considered as Sunday-WE. Thus, the time period was classified into holidays (WE + festive days) and weekdays (WD), and daytime (8:00 am -8:00 pm) and nighttime (8:00 pm -8:00 am). IHM and LOS were assumed as primary and secondary objectives, respectively. Patients were classified into deceased and survivors, and LOS was classified depending on length lower or higher than the median (seven days). T-test, chi-squared test, U Mann-Whitney test, and logistic regression analysis were performed.Results: During the 18-month period, 13,237 consecutive patients visiting the ED (43.4% males, mean age 74.8 ± 13.6 years, 56.6% females, mean age 78.0 ± 13.3 years), were considered. IHM was related to: time of admission (daytime vs. nighttime, p = .015; WE vs. WD, p = .026, holidays vs. no holidays, p = .021), colour code (p < .001), and age (p < .001). Multivariate analysis showed an independent association with IHM for colour code (p < .001), and age (p < .001). LOS >7 days was related to: time of admission (daytime vs. nighttime, p < .001; WE or WD, p = .001; holidays vs. no holidays, p = .002). Furthermore, LOS >7 days depended on both colour code of admission (p < .001), and age (p < .001). Multivariate analysis showed a significant correlation with LOS >7 days for yellow colour code (p < .001), and age (p < .001). Conclusions:Although several factors, such as admission colour code and age, influence some parameters of clinical outcome, i.e., IHM and LOS, a striking weekend effect is not evident in a cohort of consecutive patients admitted to an Italian Medical Department, characterized by intermediate-high level of urgency.

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Section: Discussioncontrasting

confidence: 87%

In-hospital mortality and length-of-stay in a cohort of ED patients admitted to internistic units

Giorgi¹,

Fabbian²,

Ferro³

et al. 2013

JHA

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“…We used the risk-adjusted figures reported in the published studies that have been cited as support for the 7-day services initiative. We applied the inverse of the risk-adjusted odds ratios reported by Freemantle et al 3 and by Aylin et al 15 to the odds [p/(1 -p)] of mortality at weekends observed in our data. This represents the expected odds of mortality if weekend patients experienced the same death rate as those admitted during the week once we control for their risk characteristics.…”

Section: Study 1: Estimating the Potential Costs And Benefits Of Intrmentioning

confidence: 99%

“…[1][2][3][4] Although there is evidence for this phenomenon in all out-of-hours periods -principally at night and at weekends -it has become known as the 'weekend effect' because the seminal studies in this area concentrated on weekend admissions.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…3 This weekend effect varies substantially by condition, from a zero additional risk for pneumonia to 16% for stroke, 28% for lung cancer and 37% for renal failure. 3 To interpret these weekend effects it is important to consider the baseline level of risk. In the review commissioned by the NHS Services, Seven Days a Week Forum, 25 only one study, by Aylin et al, 15 presented actual mortality rates for patients admitted at the weekend and during the week.…”

Section: Introductionmentioning

confidence: 99%

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Variations in mortality across the week following emergency admission to hospital: linked retrospective observational analyses of hospital episode data in England, 2004/5 to 2013/14

Han

Meacock

Anselmi

et al. 2017

Health Serv Deliv Res

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Background Patients admitted to hospital outside normal working hours suffer higher complication and mortality rates than patients admitted at times when the hospital is fully operational. This ‘weekend effect’ is well described but poorly understood. It is not clear whether or not the effect extends to other out-of-hours periods, or how far excess mortality for out-of-hours admissions reflects a different presenting population with higher severity of illness and how much is explained by poorer availability and quality of services. Objectives We aimed to assess (1) the costs and benefits of introducing 7-day services, (2) whether or not mortality rates are elevated during all out-of-hours periods, (3) whether or not selection of more severely ill patients for admission out of hours explains elevated mortality rates and (4) whether or not mortality rates out of hours are related to staffing levels. Methods We conducted a series of retrospective observational analyses of hospital episode data in England, using both national data and data from a single, large acute NHS trust. For the national studies, we analysed emergency admissions to all 140 non-specialist acute hospital trusts in England between April 2013 and February 2014 (over 12 million accident and emergency attendances and 4.5 million emergency admissions). For the single trust, we analysed emergency admissions between April 2004 and March 2014 (240,000 admissions). Deaths within 30 days of attendance or admission were compared for normal working hours and out-of-hours periods. Results We found that, in addition to elevated mortality for weekend admissions, mortality rates are also elevated for patients admitted during night-time periods. Elevated mortality was reduced for stroke patients in a large acute trust when more – and more experienced – nursing staff were present during the first hour of admission. Nationally, we found that excess mortality out of hours was largely explained by a sicker population of patients being selected for admission. However, mortality rates were still elevated on Sunday daytimes when we accounted for severity of patient illness. We also found that the estimated cost of implementing 7-day services exceeds the maximum amount that the National Institute for Health and Care Excellence would recommend the NHS should spend on eradicating excess mortality at weekends. Limitations Our results depend on the accuracy and completeness of data recording by hospital staff. If accuracy of recording is related to time of patient admission, our results may be biased. Results based on data from a single trust should be treated as indicative. Conclusions In addressing variations in patient outcomes across the week, a more nuanced approach, extending services for key specialties over critical periods – rather than implementing whole-system changes – is likely to be the most cost-effective. Future work Future research should aim to develop and use appropriate measures of severity of illness to facilitate meaningful analysis of variations in patient outcomes, and to identify candidate specialties and critical periods for which extending services is likely to be cost-effective. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Retrospective analysis of 30-day mortality for emergency general surgery admissions evaluating the weekend effect

McCallum

McLean

Dixon

et al. 2016

Journal of British Surgery

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Background:The weekend effect describes excess mortality associated with hospital admission on Saturday or Sunday. This study assessed whether a weekend effect exists for patients admitted for emergency general surgery. There was no significant mortality difference for patients admitted at the weekend in adjusted Cox models (hazard ratio (HR) 1⋅00 for Saturday and 0⋅90 for Sunday, versus Wednesday). There was a significantly higher mortality for operations undertaken at the weekend (HR 1⋅15 for Saturday and 1⋅40 for Sunday; P = 0⋅021 and P < 0⋅001 respectively). The significantly increased mortality that was evident for emergency surgery at the weekend compared with weekdays in 2000-2004 (HR 1⋅46 for Saturday and 1⋅55 for Sunday; both P < 0⋅001); had reduced by 2010-2014, when the adjusted mortality risk was not significant (HR 1⋅18 for Saturday and 1⋅12 for Sunday).Conclusion: During the past 15 years there has been a weekend effect in patients undergoing emergency general surgery based on day of operation, but not day of admission. Overall mortality for emergency general surgery has improved significantly, and in the past 5 years the increased mortality risk of weekend surgery has reduced.

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Weekend hospitalization and additional risk of death: An analysis of inpatient data

Abstract: Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day.

Cited by 276 publications

References 11 publications

In-hospital mortality and length-of-stay in a cohort of ED patients admitted to internistic units

In-hospital mortality and length-of-stay in a cohort of ED patients admitted to internistic units

Variations in mortality across the week following emergency admission to hospital: linked retrospective observational analyses of hospital episode data in England, 2004/5 to 2013/14

Retrospective analysis of 30-day mortality for emergency general surgery admissions evaluating the weekend effect

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