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Magnitude and modifiers of the weekend effect in hospital admissions : a systematic review and meta-analysis

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Chen, Yen-Fu, Armoiry, Xavier, Higenbottam, Caroline, Cowley, Nicholas, Basra, Rajna, Watson, Samuel I., Tarrant, Carolyn, Boyal, Amunpreet, Sutton, Elizabeth, Wu, Chia-Wei, Aldridge, Cassie P., Gosling, Amy, Lilford, Richard and Bion, Julian (2019) Magnitude and modifiers of the weekend effect in hospital admissions : a systematic review and meta-analysis. BMJ Open, 9 (6). e025764. doi:10.1136/bmjopen-2018-025764

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Official URL: https://doi.org/10.1136/bmjopen-2018-025764

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Abstract

To examine the magnitude of the weekend effect, defined as differences in patient outcomes between weekend and weekday hospital admissions, and factors influencing it. A systematic review incorporating Bayesian meta-analyses and meta-regression. We searched seven databases including MEDLINE and EMBASE from January 2000 to April 2015, and updated the MEDLINE search up to November 2017. Eligibility criteria: primary research studies published in peer-reviewed journals of unselected admissions (not focusing on specific conditions) investigating the weekend effect on mortality, adverse events, length of hospital stay (LoS) or patient satisfaction. For the systematic review, we included 68 studies (70 articles) covering over 640 million admissions. Of these, two-thirds were conducted in the UK (n=24) or USA (n=22). The pooled odds ratio (OR) for weekend mortality effect across admission types was 1.16 (95% credible interval 1.10 to 1.23). The weekend effect appeared greater for elective (1.70, 1.08 to 2.52) than emergency (1.11, 1.06 to 1.16) or maternity (1.06, 0.89 to 1.29) admissions. Further examination of the literature shows that these estimates are influenced by methodological, clinical and service factors: at weekends, fewer patients are admitted to hospital, those who are admitted are more severely ill and there are differences in care pathways before and after admission. Evidence regarding the weekend effect on adverse events and LoS is weak and inconsistent, and that on patient satisfaction is sparse. The overall quality of evidence for inferring weekend/weekday difference in hospital care quality from the observed weekend effect was rated as 'very low' based on the Grading of Recommendations, Assessment, Development and Evaluations framework. The weekend effect is unlikely to have a single cause, or to be a reliable indicator of care quality at weekends. Further work should focus on underlying mechanisms and examine care processes in both hospital and community. CRD42016036487. [Abstract copyright: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.]

Item Type: Journal Article
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Mortality—Statistics, Medical statistics -- Data processing, Medical care -- Evaluation, Medical care -- Quality control, Public health -- Research -- Methodology
Journal or Publication Title: BMJ Open
Publisher: BMJ
ISSN: 2044-6055
Official Date: 4 June 2019
Dates:
DateEvent
4 June 2019Published
4 June 2019Available
15 April 2019Accepted
Volume: 9
Number: 6
Article Number: e025764
DOI: 10.1136/bmjopen-2018-025764
Status: Peer Reviewed
Publication Status: Published
Publisher Statement: ** From PubMed via Jisc Publications Router
Access rights to Published version: Open Access
Description:

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Correction: Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis
British Medical Journal Publishing Group
BMJ Open 2019; 9 - Published Online First: 27 Jun 2019. doi: 10.1136/bmjopen-2018-025764corr1

RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
12/128/17Health Services and Delivery Research Programmehttp://dx.doi.org/10.13039/501100002001
UNSPECIFIEDNational Institute for Health Research (Great Britain). Collaboration for Leadership in Applied Health Research and Care West MidlandsUNSPECIFIED
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