Abstract
Background: Weekend admission has been found to be associated with higher hospital mortality and longer hospital stay among patients with acute cardiovascular conditions. Whether those admitted on Fridays face similar risk as those admitted on Sundays and Saturdays remain uncertain.Methods: This study used 2012–2013 data from hospital records for nonfatal patients with ischemic stroke in the state of South Carolina. The database contained the records of all hospitalizations in South Carolina except military and federal institutions. Multilevel logistic, negative binomial, and log-linear regression models were performed to explore the temporal pattern by hospital admission on specific day of a week for three outcomes: discharge to hospice care (vs. other alive discharges), length of stay, and total charge, respectively. Each model controlled for the patient age, gender, race/ethnicity, year of hospital admission, season of admission, payer, and Charlson Comorbidity Index.Results: A total of 19,346 nonfatal ischemic stroke hospitalizations were identified. Multilevel logistic regression shows that patients admitted on non-Friday weekdays had a significantly lower odds of being discharged to hospice care as compared with those admitted on Fridays [odds ratio = 0.80, 95% confidence interval (CI) = 0.65–0.99] where there was no significant difference between Friday admissions and weekend admissions. The length of hospital stay for admission on non-Friday weekdays was significantly shorter than that of Friday admissions [incident rate ratio (IRR) = 0.87, 95% CI = 0.84–0.90], whereas longer length of hospital stay was found on weekend admission (IRR = 1.06, 95% CI = 1.02–1.11). Friday admissions were not associated with higher charges as compared with non-Friday weekday admissions.Conclusions: Some hospitalization outcomes admitted on Fridays seemed to have the “weekend effects” too. Further studies are warranted to investigate underlying mechanism for such a difference in outcomes between Friday and other weekdays. Interventions to close the weekend–weekday gap of patient outcomes need to consider the elevated risk on Friday admission.
Highlights
Ample literature has shown that the mortality among patients with severe acute conditions is higher for weekend hospital admission than weekdays [1,2,3,4,5,6,7,8,9,10,11]
Most previous studies used the weekend versus weekday dichotomy. Such dichotomization limits the opportunity to detect more specific temporal patterns on transitional days. It is common in the literature of the “weekend effect” that patients discharged for hospice care were coded as survivors as other alive discharges
We aimed to investigate whether the weekend effect started earlier by comparing ischemic stroke patients admitted on Fridays versus patients admitted on non-Friday weekdays and weekends for three hospital outcomes: discharge to hospice care versus other alive discharges, length of stay, and total hospital charges
Summary
Ample literature has shown that the mortality among patients with severe acute conditions is higher for weekend hospital admission than weekdays [1,2,3,4,5,6,7,8,9,10,11]. Most previous studies used the weekend versus weekday dichotomy Such dichotomization limits the opportunity to detect more specific temporal patterns on transitional days. It is common in the literature of the “weekend effect” that patients discharged for hospice care were coded as survivors as other alive discharges. Weekend admission has been found to be associated with higher hospital mortality and longer hospital stay among patients with acute cardiovascular conditions. Whether those admitted on Fridays face similar risk as those admitted on Sundays and Saturdays remain uncertain
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