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Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust
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Sun, Jianxia, Girling, Alan J., Aldridge, Cassie, Evison, Felicity, Beet, Chris, Boyal, Amunpreet, Rudge, Gavin, Lilford, Richard and Bion, Julian (2019) Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust. BMJ Quality & Safety, 28 (3). pp. 223-230. doi:10.1136/bmjqs-2018-008219 ISSN 2044-5423.
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Official URL: https://doi.org/10.1136/bmjqs-2018-008219
Abstract
Objective
To determine whether the higher weekend admission mortality risk is attributable to increased severity of illness.
Design
Retrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England.
Outcome measures
30-day postadmission weekend:weekday mortality ratios adjusted for severity of illness (baseline National Early Warning Score (NEWS)), routes of admission to hospital, transfer to the intensive care unit (ICU) and demographics.
Results
Despite similar emergency department daily attendance rates, fewer patients were admitted on weekends (mean admission rate 91/day vs 120/day) because of fewer general practitioner referrals. Weekend admissions were sicker than weekday (mean NEWS 1.8 vs 1.7, p=0.008), more likely to undergo transfer to ICU within 24 hours (4.2% vs 3.0%), spent longer in hospital (median 3 days vs 2 days) and less likely to experience same-day discharge (17.2% vs 21.9%) (all p values <0.001). The crude 30-day postadmission mortality ratio for weekend admission (OR=1.13; 95% CI 1.08 to 1.19) was attenuated using standard adjustment (OR=1.11; 95% CI 1.05 to 1.17). In patients for whom NEWS values were available (90%), the crude OR (1.07; 95% CI 1.01 to 1.13) was not affected with standard adjustment. Adjustment using NEWS alone nullified the weekend effect (OR=1.02; 0.96–1.08). NEWS completion rates were higher on weekends (91.7%) than weekdays (89.5%). Missing NEWS was associated with direct transfer to intensive care bypassing electronic data capture. Missing NEWS in non-ICU weekend patients was associated with a higher mortality and fewer same-day discharges than weekdays.
Conclusions
Patients admitted to hospital on weekends are sicker than those admitted on weekdays. The cause of the weekend effect may lie in community services.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||||
| Library of Congress Subject Headings (LCSH): | Emergency medicine -- England, Hospitals -- Admission and discharge -- England, Community health services -- England, University hospitals -- England, Patients -- England | ||||||||
| Journal or Publication Title: | BMJ Quality & Safety | ||||||||
| Publisher: | BMJ Publishing Group | ||||||||
| ISSN: | 2044-5423 | ||||||||
| Official Date: | 19 February 2019 | ||||||||
| Dates: |
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| Volume: | 28 | ||||||||
| Number: | 3 | ||||||||
| Page Range: | pp. 223-230 | ||||||||
| DOI: | 10.1136/bmjqs-2018-008219 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Reuse Statement (publisher, data, author rights): | ** From BMJ via Jisc Publications Router. ** History: received 30-04-2018; rev-recd 22-08-2018; accepted 23-08-2018; ppub 10-2018; epub 09-10-2018. ** Licence for this article: http://creativecommons.org/licenses/by/4.0/ | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 23 November 2018 | ||||||||
| Date of first compliant Open Access: | 23 November 2018 | ||||||||
| RIOXX Funder/Project Grant: |
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