Weekend Emergency Hospital Admissions are Risky

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Being admitted to a hospital for an emergency over a weekend is risky business, according to a new study in the Archives of Surgery. What begins as a weekend emergency visit is more likely to end in death than is an admission on a weekday.

Inhospital mortality is higher for weekend admissions

Researchers from Tufts University Medical School analyzed data from the Nationwide Inpatient Sample, which includes about 20 percent of community hospitals in the United States. Information from 29,991,621 patients (mean age 46 years) with a broad range of diagnoses was analyzed. The selected patients had been admitted to a hospital for nonelective reasons from 2003 through 2007, and 28.8 percent were admitted on a weekend.

Researchers found that inhospital mortality rate was significantly higher for individuals who were admitted on the weekend (2.7%) than for those admitted during the week (2.3%). Overall, after adjusting for age, sex, race, income and payer, hospital characteristics, and other health conditions, being admitted on the weekend was associated with a 10.5 percent greater chance of dying.

According to Rocco Ricciardi, MD, MPH, and his colleagues, the fact that the data was consistent given all the variables they considered “indicates that a central and common factor is most likely responsible for the unfavorable outcomes.”

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Weekend hospital admission was associated with a significantly higher mortality in 15 of 26 major diagnostic categories, including myeloproliferative disorders (e.g., chronic myelogenous leukemia, essential thrombocythemia), pregnancy and childbirth, and female reproductive system procedures. Ten categories showed no significant difference, and for the category of mental health, mortality associated with weekend admission was lower.

The study’s authors note that it is unclear why weekend admissions are associated with a higher risk of death. However, it suggests “a common structural or process measure,” given the investigators had ruled out comorbidities.

The authors also noted there was a “lack of a significant difference in admission mortality rate for trauma or burn care.” This is a good indicator because “the evaluation and management of trauma and burns incorporate structured algorithms for care that likely reduced much of the variability in care practice that may be appreciated with other conditions.”

For now, it is still unclear why weekend emergency admissions to the hospital are associated with a higher risk of death. Based on previous studies, reduced experience of the staff and low staffing levels on weekends could explain the findings. One limitation of the current study was an inability to adjust for the patients’ disease severity at presentation.

SOURCE:
Ricciardi R et al. Archives of Surgery 2011; 146: 545-51

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