Mortality For Weekend Admissions Research Articles

Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study

SummaryBackgroundIncreased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service.MethodsEligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013–14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile.Findings127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34 350 clinicians surveyed, 15 537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40–58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients admitted at weekends was higher than among those admitted on weekdays (adjusted odds ratio 1·10, 95% CI 1·08–1·11; p<0·0001). There was no significant association between Sunday to Wednesday specialist intensity ratios and weekend to weekday mortality ratios (r −0·042; p=0·654).InterpretationThis cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions. Further investigation is needed to evaluate whole-system secular change during the implementation of 7 day services. Policy makers should exercise caution before attributing the weekend effect mainly to differences in specialist staffing.FundingNational Institute for Health Research Health Services and Delivery Research Programme.

Response to Letter by Janszky et al

HomeStrokeVol. 38, No. 9Response to Letter by Janszky et al Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter by Janszky et al Gustavo Saposnik, MD, MSc Gustavo SaposnikGustavo Saposnik Director, Stroke Research Program, St. Michael’s Hospital and SE Toronto Regional Stroke Center, Assistant Professor in Medicine, University of Toronto, Toronto, Canada Search for more papers by this author Originally published26 Jul 2007https://doi.org/10.1161/STROKEAHA.107.492546Stroke. 2007;38:e95Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: July 26, 2007: Previous Version 1 Response:We would like to thank Dr Janszky and colleagues for their interest in our article and data provided.1 They analyzed the weekend effect in the Swedish Hospital Discharge Register (unpublished data).2 Dr Janszky and colleagues found higher adjusted mortality and lesser discharge home for patients admitted on weekends with ischemic cerebral infarction, and also for patients with hemorrhagic stroke.These results confirm the importance of our observation in a different region, setting and healthcare system emphasizing the variability in stroke disability and mortality for weekend admissions. Further studies are necessary to better understand the underlying mechanisms of this phenomenon and the impact of other health system variables on stroke outcome.3–5DisclosuresNone.1 Saposnik G, Baibergenova A, Bayer N, Hachinski V. Weekends: a dangerous time for having a stroke? Stroke. 2007; 38: 1211–1215.LinkGoogle Scholar2 Schaufelberger M, Swedberg K, Koster M, Rosen M, Rosengren A. Decreasing one-year mortality and hospitalization rates for heart failure in Sweden: data from the Swedish Hospital Discharge Registry 1988 to 2000. Eur Heart J. 2004; 25: 300–307.CrossrefMedlineGoogle Scholar3 Saposnik G, Baibergenova A, O’Donnell M, Hill M, Kapral M, Hachinski V. Hospital volume and stroke mortality: does it matter? Neurology. 2007; 69: 1–11.Google Scholar4 Goldstein LB, Matchar DB, Hoff-Lindquist J, Samsa GP, Horner RD. VA stroke study: neurologist care is associated with increased testing but improved outcomes. Neurology. 2003; 61: 792–796.CrossrefMedlineGoogle Scholar5 Kapral MK, Wang H, Mamdani M, Tu JV. Effect of socioeconomic status on treatment and mortality after stroke. Stroke. 2002; 33: 268–273.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails September 2007Vol 38, Issue 9 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.107.492546 Originally publishedJuly 26, 2007 PDF download Advertisement

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.