Association of Weekend Admission and Clinical Outcomes in Hospitalised Adult Patients with Sepsis

Abstract

Background: Sepsis is associated with detrimental clinical outcomes. It requires early diagnosis and urgent therapeutic intervention. Because staffing during after-hours is limited, we explored whether after-hour admissions are associated with worse clinical outcomes in patients with sepsis. Methods: In this cohort study, we analysed nationwide acute care admissions for a main diagnosis of sepsis in Switzerland between 2006 and 2016 using prospective administrative data. The primary outcome was in-hospital mortality using multivariate logistic regression models. Secondary outcomes were intensive care unit (ICU) admission, intubation, and 30-day readmission. Findings: We included 86`597 hospitalisations for sepsis, 60·1% admitted during routine-hours, 16·8% on weekends and 23·1% at night. Compared to routine-hour admissions, we found a higher risk for in-hospital mortality in patients admitted on weekends (20·0% vs. 19·2%, adjusted odds ratio [OR] 1·05, 95% confidence interval [95% CI] 1·01-1·10, p=0·029). Also, the risk for ICU admission (30·5% vs. 28·0%, OR 1·14, 95% CI 1·10-1·19, p<0·0001) and intubation (14·7% vs. 12·9%, OR 1·18, 95% CI 1·12-1·25 p<0·0001) was higher for weekends compared to routine-hour admissions. There were no differences in 30-day readmission rates. Night shift admission, compared to routine-hour admission, also had a higher risk for ICU admission and intubation, whereas in-hospital mortality was not increased. Interpretation: Among hospitalisations with a main diagnosis of sepsis, weekend admissions were associated with higher risk for in-hospital mortality, ICU admission, and intubation. Whether these findings can be explained by staffing-level differences needs to be addressed. Funding Statement: Swiss National Science Foundation (SNF_407440_167376) Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Ethics Commission Northwest and Central Switzerland approved the study.