Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust. Issue 3 (9th October 2018)

• Record Type: Journal Article
• Authors: Sun, Jianxia; Girling, Alan J; Aldridge, Cassie; Evison, Felicity; Beet, Chris; Boyal, Amunpreet; Rudge, Gavin; Lilford, Richard J; Bion, Julian
• Is Part Of: BMJ quality & safety. Volume 28:Issue 3(2019)
• Page Start: 223
• Page End: 230
• Publication Date: 2018-10-09
• Subjects: mortality (standardized mortality ratios) -- patient safety -- duty hours/work hours -- emergency department -- hospital medicine; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2018-008219
• Languages: English
• ISSNs: 2044-5415

Abstract

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. Outcome measures: 30-day postadmission weekend:weekday 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.