Abstract
Background: a number of studies highlighted increased mortality associated with hospital admissions during weekends and holidays, the so–call “weekend effect”. In this retrospective study of mortality in an acute care public hospital in Italy between 2009 and 2015, we compared inpatient mortality before and after a major organizational change in 2012. The new model (Model 2) implied that the intensivist was available on call from outside the hospital during nighttime, weekends, and holidays. The previous model (Model 1) ensured the presence of the intensivist coordinating a Medical Emergency Team (MET) inside the hospital 24 h a day, 7 days a week. Methods: life status at discharge after 9298 and 8223 hospital admissions that occurred during two consecutive periods of 1185 days each (organizational Model 1 and 2), respectively, were classified into “discharged alive”, “deceased during nighttime–weekends–holidays” and “deceased during daytime-weekdays”. We estimated Relative Risk Ratios (RRR) for the associations between the organizational model and life status at discharge using multinomial logistic regression models adjusted for demographic and case-mix indicators, and timing of admission (nighttime–weekends–holidays vs. daytime-weekdays). Results: there were 802 and 840 deaths under Models 1 and 2, respectively. Total mortality was higher for hospital admissions under Model 2 compared to Model 1. Model 2 was associated with a significantly higher risk of death during nighttime–weekends–holidays (IRR: 1.38, 95% CI 1.20–1.59) compared to daytime–weekdays (RRR: 1.12, 95% CI 0.97–1.31) (p = 0.04). Respiratory diagnoses, in particular, acute and chronic respiratory failure (ICD 9 codes 510–519) were the leading causes of the mortality excess under Model 2. Conclusions: our data suggest that the immediate availability of an intensivist coordinating a MET 24 h, 7 days a week can result in a better prognosis of in-hospital emergencies compared to delayed consultation.
Highlights
Since the end of the first decade of the 2000s, the public expenditure in Italy has been progressively reduced as a consequence of the economic crisis to comply with the European economic parameters imposed by the Treaties
We found an excess of mortality mainly due to acute and chronic respiratory failure (ICD 9 codes 510–519)
The aim of this study was to compare the two different emergency medicine organizational models in terms of in-hospital mortality, with a focus on the timing of admission and discharge, under the hypothesis that a delayed bedside critical care treatment could result in worse outcomes compared to immediate treatment in a fragile population of hospitalized patients
Summary
Since the end of the first decade of the 2000s, the public expenditure in Italy has been progressively reduced as a consequence of the economic crisis to comply with the European economic parameters imposed by the Treaties. Treaty (1992) was the first that bound European countries to strive for fiscal convergence to the 3% deficit to gross domestic product (GDP) ratio and the 60% debt on GDP ratio. The Stability and Growth Pact (SGP, 1997) introduced a control and sanction system and the “medium-term objective” (MTO), imposing countries with a debt to GDP ratio over. The Treaty on Stability, Coordination, and Governance in the monetary union (TSCG known as the Fiscal Compact), introduced in 2013, provided for the inclusion of European rules in countries’ own legislative systems.
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