Abstract
ObjectivePatients admitted during weekends may have worse outcomes than those during weekdays. Adjusting the practice of senior physicians over weekends may reduce the weekend effect.DesignA controlled before-after study, with propensity score matching (PSM) for potential confounding variables, to compare outcomes between weekday and weekend admissions.SettingA 2000-bed medical centre in TaiwanParticipantsHospitalised general medicine patients cared for by traditional internal medicine teams (pre-intervention cohort) and those cared for by hospitalists after introducing a seven-day hospitalist program in the first six-month (post-intervention cohort) and following three-year periods.Main outcome measuresProportion of intensive care unit (ICU) admissions, cardiopulmonary resuscitation (CPR) events, and in-hospital mortality.ResultsThe pre-intervention cohort included 982 patients. Significantly higher mortality rates (11.3% vs. 6.2%, p = 0.032) were recorded in the case of weekend admissions, with similar proportions of ICU admission and CPR events. The post-intervention cohort included 601 patients. No significant difference was recorded in any of the main outcomes between weekday and weekend admissions. PSM for pre-intervention and post-intervention cohort showed shorter LOS after intervention, with no difference in ICU admission, CPR, and morality for the weekday and weekend admissions, respectively. The three-year cohort that followed, consisting of 3315 patients, showed no difference of outcomes between weekday and weekend admissions. After PSM, there were no significant differences in ICU admission rates (1.0% vs. 1.8%), CPR (0.3% vs. 0.2%) events and hospital mortality rates (8.1% vs. 8.5%), when weekday and weekend admissions were compared.ConclusionsThe seven-day hospitalist program shows potential in providing equally safe care for both weekday and weekend general medicine admissions with sustainable development.
Highlights
Several studies have reported that higher mortality rates were observed in patients admitted to hospitals on weekends, especially in the case of emergency admissions [1,2,3]
After propensity score matching (PSM), there were no significant differences in intensive care unit (ICU) admission rates (1.0% vs. 1.8%), cardiopulmonary resuscitation (CPR) (0.3% vs. 0.2%) events and hospital mortality rates (8.1% vs. 8.5%), when weekday and weekend admissions were compared
It has been hypothesised that weekend effect results from different staffing between weekdays and weekends [4], but hospitalists are typically available at weekends
Summary
Several studies have reported that higher mortality rates were observed in patients admitted to hospitals on weekends, especially in the case of emergency admissions [1,2,3]. Possible explanations for this ‘weekend effect’ may include differences in staffing [4], the unavailability of important procedures [5] and variations in the patient cohorts [6]. Introducing hospitalists into the traditional inpatient care model can potentially provide equal quality of care during weekends because of the typical 24-hours/7-day coverage [17]
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