289 Mortality Rate Weekdays versus Weekends for Adult Patients Presenting to US Emergency Departments

Abstract

Background: In the U.S. not all health care services are available 24/7. It is assumed that serious life-threatening conditions receive appropriate care regardless of time of day or day of the week, and less serious elective services are the ones relegated to Monday-Friday. Spain and Canada have shown this assumption false, prompting further investigation to eliminate higher mortality rates on the weekend. It is not currently known if similar disparities exist in the U.S or if our system is more consistent as shown in the evaluation of Great Britain.Study Objective: Determine if the mortality rate for adult patients admitted through US emergency departments (ED) varies on weekends versus weekdays. Identify patient- and hospital-level characteristics that have an effect on differences in weekday versus weekend mortality.Methods: Design: A retrospective cohort analysis of the 2008 Nationwide Emergency Department Sample (NEDS) using logistic regression clustered at the hospital level. Analysis was adjusted for comorbidities, age, sex, income and insurance status for individuals. At the hospital-level analysis was adjusted for ED volume, trauma status, teaching status, and ownership. Setting: The 2008 NEDS is a 20% sample representative of U.S. emergency departments. NEDS is part of the Health care Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). It is a compilation of the State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID).Participants: 4,226,800 adults admitted to the hospital, or dying after presenting to an ED in 2008.Results: Mortality rates differed between weekdays and weekends OR=1.073 (p< 0.001). This difference was maintained OR=1.026 (p=0.012) after adjusting for individual and hospital level variables. The adjusted marginal differences in weekend mortality were highest for self-pay and Medicaid patients. In contrast to previous state analysis there was not a significant difference in weekend mortality rate for teaching hospitals compared to non-teaching hospitals (p=0.077).Conclusion: Patients are more likely to die when admitted to the hospital through the ED on the weekend compared to weekdays. Further research is needed to identify the root cause of this difference in order to target system changes that avoid unnecessary death. Background: In the U.S. not all health care services are available 24/7. It is assumed that serious life-threatening conditions receive appropriate care regardless of time of day or day of the week, and less serious elective services are the ones relegated to Monday-Friday. Spain and Canada have shown this assumption false, prompting further investigation to eliminate higher mortality rates on the weekend. It is not currently known if similar disparities exist in the U.S or if our system is more consistent as shown in the evaluation of Great Britain. Study Objective: Determine if the mortality rate for adult patients admitted through US emergency departments (ED) varies on weekends versus weekdays. Identify patient- and hospital-level characteristics that have an effect on differences in weekday versus weekend mortality. Methods: Design: A retrospective cohort analysis of the 2008 Nationwide Emergency Department Sample (NEDS) using logistic regression clustered at the hospital level. Analysis was adjusted for comorbidities, age, sex, income and insurance status for individuals. At the hospital-level analysis was adjusted for ED volume, trauma status, teaching status, and ownership. Setting: The 2008 NEDS is a 20% sample representative of U.S. emergency departments. NEDS is part of the Health care Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). It is a compilation of the State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID). Participants: 4,226,800 adults admitted to the hospital, or dying after presenting to an ED in 2008. Results: Mortality rates differed between weekdays and weekends OR=1.073 (p< 0.001). This difference was maintained OR=1.026 (p=0.012) after adjusting for individual and hospital level variables. The adjusted marginal differences in weekend mortality were highest for self-pay and Medicaid patients. In contrast to previous state analysis there was not a significant difference in weekend mortality rate for teaching hospitals compared to non-teaching hospitals (p=0.077). Conclusion: Patients are more likely to die when admitted to the hospital through the ED on the weekend compared to weekdays. Further research is needed to identify the root cause of this difference in order to target system changes that avoid unnecessary death.