Effects of weekend admission and hospital teaching status on in-hospital mortality☆
Section snippets
Data source
We used the 1998 California Office of Statewide Health Planning and Development Discharge Data File, which was developed as part of the Healthcare Cost and Utilization Project conducted by the Agency for Healthcare Research and Quality (AHRQ) (12). The dataset contains detailed administrative data for all admissions during 1998 to all licensed acute care hospitals (excluding Veterans Administration hospitals) in California. Trained abstractors working on site collected demographic and clinical
Results
During 1998 there were 3,725,373 admissions to acute care hospitals in California and 86,557 deaths. The 50 study diagnoses were responsible for 1,100,984 admissions (30% of all admissions) and 64,840 deaths (75% of all deaths). Exclusion of scheduled admissions (n = 191,153) and patients who had not been admitted from the emergency department (n = 267,971) resulted in a final cohort of 641,860 patients and 41,702 deaths. An additional 71,700 patients were excluded from the teaching status
Discussion
This study demonstrates that patients admitted to hospitals in California from the emergency department on weekends had a minimally increased odds of dying during hospitalization when compared with patients admitted on weekdays. The study also demonstrates the potential influence of selection bias on studies measuring the weekend effect. Analyzing three progressively restrictive cohorts, the weekend effect declined as selection criteria increased, and, importantly, as the proportion of weekend
Acknowledgements
The authors would like to express their thanks to Sanjay Saint, Tim Hofer, and A. Mark Fendrick for their assistance with a closely related project.
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2021, Surgery (United States)Citation Excerpt :In addition, there have been several possible theories to explain this weekday effect such as lower weekend staffing,4,5 reduced services during weekends,6 and less experienced surgeons being on duty.5 Although studies in various medical fields have addressed the weekday effect, the results are conflicting.2,3,6−9 A US study conducted across Veterans Affairs hospitals have demonstrated a significantly higher 30-day mortality for patients who underwent nonemergency surgery on Fridays compared with those performed on early weekdays.2
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Funded in part by a Research Enhancement Award (01-094) from the Health Services Research and Development Service, Veterans Health Administration, Department of Veterans Affairs. Dr. Rosenthal is a Senior Quality Scholar, Office of Academic Affiliations, Veterans Health Administration.