Impact of weekend admissions on quality of care and outcomes in patients with acute myeloid leukemia.

Abstract

Hospital services are expectantly reduced over the weekend, which may result in a delay in treatment or in obtainment of medical procedures. The authors investigated quality of care and clinical outcomes of newly diagnosed acute myeloid leukemia (AML) patients who were hospitalized on weekends versus weekdays and treated with induction chemotherapy.
This retrospective follow-up study involved 422 AML patients treated with cytarabine-based induction chemotherapy at Cleveland Clinic from 1994-2008. Quality outcome measures included time to triple-lumen catheter (TLC) placement, time to induction chemotherapy, length of stay (LOS), early death (within 15 days of chemotherapy), and 30-day mortality. These were tested for the association with known predictors of AML survival and etiology by the methods of linear, categorical, and survival analyses.
Twenty-three percent of all admissions (n=422) occurred over the weekend (n=103). Compared with younger (aged<60 years) patients, older patients had higher 30-day mortality (P=.003), early death (P=.025), and time to induction rates (P=.02), but lower complete remission (P=.001) and overall survival (OS) rates (P<.0001). In univariate analyses, time to TLC was delayed for weekend admissions (P<.01). Weekend admissions had lower early mortality (P=.04) and 30-day mortality (P=.02). In multivariate analysis, only time to TLC remained significantly longer for weekend admissions (P<.001).
Weekend admissions significantly delayed placement of TLC without affecting other quality parameters or patient survival. This is likely because of immediate initiation of peripheral chemotherapy with cytarabine even before the placement of TLC for infusion of anthracyclines.