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BMJ Qual Saf 23:215-222 doi:10.1136/bmjqs-2013-002218
  • Original research

Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study

Open AccessEditor's Choice
  1. Enrico Coiera1
  1. 1Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Kensington, New South Wales, Australia
  2. 2SWS Clinical School, Liverpool Hospital, University of New South Wales, Kensington, New South Wales, Australia
  3. 3The Simpson Centre for Health Services Research, Australian Institute of Health Innovation, University of New South Wales, Kensington, New South Wales, Australia
  4. 4Sydney South West Local Health District, Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
  1. Correspondence to Professor Enrico Coiera, Centre for Health Informatics, Australian Institute of Health Innovation, Level 1, AGSM Building, G27, University of New South Wales, Kensington, NSW 2052, Australia; e.coiera{at}unsw.edu.au
  • Received 9 June 2013
  • Revised 15 September 2013
  • Accepted 21 September 2013
  • Published Online First 25 October 2013

Abstract

Background Proposed causes for increased mortality following weekend admission (the ‘weekend effect’) include poorer quality of care and sicker patients. The aim of this study was to analyse the 7 days post-admission time patterns of excess mortality following weekend admission to identify whether distinct patterns exist for patients depending upon the relative contribution of poorer quality of care (care effect) or a case selection bias for patients presenting on weekends (patient effect).

Methods Emergency department admissions to all 501 hospitals in New South Wales, Australia, between 2000 and 2007 were linked to the Death Registry and analysed. There were a total of 3 381 962 admissions for 539 122 patients and 64 789 deaths at 1 week after admission. We computed excess mortality risk curves for weekend over weekday admissions, adjusting for age, sex, comorbidity (Charlson index) and diagnostic group.

Results Weekends accounted for 27% of all admissions (917 257/3 381 962) and 28% of deaths (18 282/64 789). Sixteen of 430 diagnosis groups had a significantly increased risk of death following weekend admission. They accounted for 40% of all deaths, and demonstrated different temporal excess mortality risk patterns: early care effect (cardiac arrest); care effect washout (eg, pulmonary embolism); patient effect (eg, cancer admissions) and mixed (eg, stroke).

Conclusions The excess mortality patterns of the weekend effect vary widely for different diagnostic groups. Recognising these different patterns should help identify at-risk diagnoses where quality of care can be improved in order to minimise the excess mortality associated with weekend admission.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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