Effect Of Weekend Admission Research Articles

Abstract WP37: The Effect of Weekend Admission on Intracerebral Hemorrhage Outcome at High Volume Institutions

INTRODUCTION: Admission for urgent care on weekends has been suggested to result in increased risk of poor outcome. Studies have suggested that admissions for intracerebral hemorrhage (ICH) have resulted in a significant increase in in-hospital mortality on a national level. The utilization of regional, high volume centers specializing in the management of acute stroke may be a potential remedy to this variability in care. We sought to test this hypothesis by examining the outcomes of ICH patients admitted to the Columbia University Medical Center Neurological ICU (NICU). Methods: The medical records of 229 ICH patients admitted to the NICU from 2009 to 2012 were identified through the Intra-Cerebral Outcomes Project prospective database and examined for weekend versus weekday admission to the NICU, as well as day versus night admission. Multiple logistic regression was used to asses for predictors of in-patient mortality and poor outcome at 3 months, defined as a modified Rankin score of 4 or greater. Outcome measures were corrected for admission severity of presentation and demographics. Results: Sixty-five admissions were recorded to have occurred on the weekend, with 14 (21.5%) patients dying in hospital. Forty-nine (29.8%) of the 164 weekday admissions resulted in mortality (p=0.27). The 3 month follow up of surviving patients was 3.4 in weekend admissions and 3.1 in weekday admissions (p= 0.93). One hundred and one night admissions occurred, with 30 in-hospital mortalities. One hundred twenty-one patients were admitted during the day shift, with 32 in-patient mortalities occurring (p=0.54). The average outcome at 3 months was 3.0 in night admissions and 3.3 in day-time admissions (p=0.39). Conclusions: No significant difference in the mortality or 3 month outcome of patients was identified regardless of day or time of admission. This may be secondary to a higher number of weekend and night duty personnel capable of being mobilized during crisis situations compared to other centers, or the increased experience of medical staff in the work up and acute management of ICH patients. When possible, aggressive diversion of patients to high volume, specialized care centers may reduce the risk of variability in care based on time of admission.

Effects of weekend admission and hospital teaching status on in-hospital mortality

Purpose The effect of reduced hospital staffing during weekends on in-hospital mortality is not known. We compared mortality rates between patients admitted on weekends and weekdays and whether weekend-weekday variation in rates differed between patients admitted to teaching and nonteaching hospitals in California. Methods The sample comprised patients admitted to hospitals from the emergency department with any of 50 common diagnoses (N = 641,860). Mortality between patients admitted on weekends and those admitted on weekdays (the “weekend effect”) was compared. The magnitude of the weekend effect was also compared among patients admitted to major teaching, minor teaching, and nonteaching hospitals. Results The adjusted odds of death for patients admitted on weekends when compared with weekdays was 1.03 (95% confidence interval [CI]: 1.01 to 1.06; P = 0.0050). Three diagnoses (cancer of the ovary/uterus, duodenal ulcer, and cardiovascular symptoms) were associated with a statistically significant weekend effect. None of the 50 diagnoses demonstrated a statistically significant reduction in mortality for weekend admissions as compared with weekday admissions. Mortality was similar among patients admitted to major (odds ratio [OR] = 1.06; 95% CI: 0.94 to 1.19) and minor (OR = 1.03; 95% CI: 0.97 to 1.09) teaching hospitals, compared with nonteaching hospitals. However, the weekend effect was larger in major teaching hospitals compared with nonteaching hospitals (OR =1.13 vs. 1.03, P = 0.03) and minor teaching hospitals (OR = 1.05, P = 0.11). Conclusion Patients admitted to hospitals on weekends experienced slightly higher risk-adjusted mortality than did patients admitted on weekdays. While overall mortality was similar for patients admitted to all hospital categories, the weekend effect was larger in major teaching hospitals and is cause for concern.