Don't get sick on the weekend: An evaluation of the weekend effect on mortality for patients visiting US EDs

Department of Emergency Medicine, Robert Wood Johnson Foundation Clinical Scholar, University of Michigan, Ann Arbor, MI 48109-2800, USA. Electronic address: .
The American journal of emergency medicine (Impact Factor: 1.27). 03/2013; 31(5). DOI: 10.1016/j.ajem.2013.01.006
Source: PubMed


PRIMARY OBJECTIVE: The primary objective of the study is to determine if the mortality for adult patients visiting US emergency departments (EDs) is greater on weekends than weekdays. SECONDARY OBJECTIVES: The secondary objective of the study is to examine whether patient factors (diagnosis, income, insurance status) or hospital characteristics (ownership, ED volume, teaching status) are associated with increased weekend mortality. METHODS: We used a retrospective cohort analysis of the 2008 Nationwide Emergency Department Sample. Evaluating 4225973 adults admitted through the ED to the hospital, signifying a 20% representative sample of US ED admissions. Logistic regression was used to examine associations of weekend mortality with patient and hospital characteristics, accounting for clustering by hospital. RESULTS: Emergency department patients admitted to the hospital on the weekend are significantly more likely to die than those admitted on weekdays (odds ratio, 1.073; 95% confidence interval, 1.061-1.084). A significant weekend effect persisted after controlling for patient characteristics (odds ratio, 1.026; 95% confidence interval, 1.005-1.048). The top 10 primary diagnoses for patients dying did not identify any specific medical condition that explained the higher weekend admission mortality. The weekend effect was also relatively consistent across patient income, insurance status, hospital ownership, ED volume, and hospital teaching status. CONCLUSION: Patients are more likely to die when admitted through the ED on the weekend. We were unable to identify specific circumstances or hospital attributes that help explain this phenomenon. Although the relative increased risk per case is small, our study demonstrates a significant number of potentially preventable weekend deaths occurring annually in the United States.

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Available from: Adam L Sharp, Sep 17, 2015
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    • "A recent publication showed a higher mortality of all patients being admitted to emergency departments in the U.S. throughout the year 2008 on weekends. Irrespective of the diagnosis [23], Egol et al. showed higher mortality rates during the night in all trauma patients from the National Trauma Data Bank in the U.S. 2002– 2006 [8]. Bell and Redelmeier showed the weekend effect for certain diseases even if the outcome is adjusted to the diagnosis [24]. "
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    ABSTRACT: Background To detect whether external factors (time of day, day of week, month and season, lunar phases) influence incidence and outcome of severely injured trauma patients. Patients and methods A retrospective cohort analysis of the TraumaRegister DGU® (TR-DGU) was carried out over a period of 10 years (January 2002–December 2011). Data of 35,432 primary admitted patients from Germany with a severe trauma (Injury Severity Score (ISS) >15) were analysed in this study. For the outcome evaluation transferred patients were excluded as well as those who did not have a valid Revised Injury Severity Classification (RISC) prognostic score. The outcome analysis could be performed in 31,596 (89.2%) patients. Incidence, demographics and injury pattern were analysed. For outcome analysis the observed hospital mortality was compared with the expected prognosis. Results Time of day was the factor that showed the highest variation in trauma incidence due to rush hours. Saturday was the day with the highest accident rate. Most accidents in the night happened on weekends. June and July were the months with the highest trauma rate with a large portion of two-wheel drivers. The days of year with the lowest trauma incidence rate were those between Christmas and New Year, and the highest rate was observed on May 1st. The outcome of the trauma patients was close to the prognosis in all investigated subgroups. Conclusion There are clear differences in incidence but not in outcome of the patients due to external factors.
    Injury 10/2014; 45:S93–S99. DOI:10.1016/j.injury.2014.08.027 · 2.14 Impact Factor

  • 10/2013; 3(2). DOI:10.5430/jha.v3n2p42
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    ABSTRACT: There is inconsistent evidence that patients with stroke admitted to hospital out of regular working hours (such as weekends) experience worse outcomes. We aimed to identify if inequalities in the quality of care and mortality exist in contemporary stroke care in England. SINAP is a prospective database of acute stroke patients, documenting details of processes of care over the first 72 hours. We compared quality of care indicators and mortality at 72 hours, 7 days and 30 days, for patients who arrived within normal hours (Monday-Friday 8am to 6pm) and for those who arrived out of hours, using multivariable logistic and Cox proportional hazard models. Quality of care was defined according to time from arrival at hospital to interventions (e.g., brain scan), and whether the patient received therapeutic interventions (such as thrombolysis). 45,726 stroke patients were admitted to 130 hospitals in England between 1 April 2010 and 31 January 2012. Patients admitted out of hours (n = 23779) had more features indicative of worse prognosis (haemorrhagic stroke, reduced consciousness, pre stroke dependency). Out of hours admission was significantly associated with longer delays in receiving a CT scan or being admitted to a stroke unit, and reduced odds of receiving thrombolysis. After adjusting for casemix, there was no consistent evidence of higher mortality for patients admitted out of hours, but patients admitted at the weekends had a higher risk of 30 day mortality (OR 1.14, 95% CI 1.06-1.21). Inequalities in the provision of stroke care for people admitted out of regular hours persist in contemporary stroke in England. The association with mortality is small and largely attributable to higher illness severity in patients admitted out of hours.
    PLoS ONE 02/2014; 9(2):e87946. DOI:10.1371/journal.pone.0087946 · 3.23 Impact Factor
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