Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust.
BMJ Qual Saf
; 28(3): 223-230, 2019 03.
Article
em En
| MEDLINE
| ID: mdl-30301873
ABSTRACT
OBJECTIVE:
To determine whether the higher weekend admission mortality risk is attributable to increased severity of illness.DESIGN:
Retrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England. OUTCOMEMEASURES:
30-day postadmission weekendweekday mortality ratios adjusted for severity of illness (baseline National Early Warning Score (NEWS)), routes of admission to hospital, transfer to the intensive care unit (ICU) and demographics.RESULTS:
Despite similar emergency department daily attendance rates, fewer patients were admitted on weekends (mean admission rate 91/day vs 120/day) because of fewer general practitioner referrals. Weekend admissions were sicker than weekday (mean NEWS 1.8 vs 1.7, p=0.008), more likely to undergo transfer to ICU within 24 hours (4.2% vs 3.0%), spent longer in hospital (median 3 days vs 2 days) and less likely to experience same-day discharge (17.2% vs 21.9%) (all p values <0.001).The crude 30-day postadmission mortality ratio for weekend admission (OR=1.13; 95% CI 1.08 to 1.19) was attenuated using standard adjustment (OR=1.11; 95% CI 1.05 to 1.17). In patients for whom NEWS values were available (90%), the crude OR (1.07; 95% CI 1.01 to 1.13) was not affected with standard adjustment. Adjustment using NEWS alone nullified the weekend effect (OR=1.02; 0.96-1.08).NEWS completion rates were higher on weekends (91.7%) than weekdays (89.5%). Missing NEWS was associated with direct transfer to intensive care bypassing electronic data capture. Missing NEWS in non-ICU weekend patients was associated with a higher mortality and fewer same-day discharges than weekdays.CONCLUSIONS:
Patients admitted to hospital on weekends are sicker than those admitted on weekdays. The cause of the weekend effect may lie in community services.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Admissão do Paciente
/
Índice de Gravidade de Doença
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Mortalidade Hospitalar
/
Plantão Médico
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Adult
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Aged
/
Female
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Humans
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Male
/
Middle aged
País como assunto:
Europa
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article