Effects of weekend admission and hospital teaching status on in-hospital mortality

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Abstract

Purpose

The effect of reduced hospital staffing during weekends on in-hospital mortality is not known. We compared mortality rates between patients admitted on weekends and weekdays and whether weekend-weekday variation in rates differed between patients admitted to teaching and nonteaching hospitals in California.

Methods

The sample comprised patients admitted to hospitals from the emergency department with any of 50 common diagnoses (N = 641,860). Mortality between patients admitted on weekends and those admitted on weekdays (the “weekend effect”) was compared. The magnitude of the weekend effect was also compared among patients admitted to major teaching, minor teaching, and nonteaching hospitals.

Results

The adjusted odds of death for patients admitted on weekends when compared with weekdays was 1.03 (95% confidence interval [CI]: 1.01 to 1.06; P = 0.0050). Three diagnoses (cancer of the ovary/uterus, duodenal ulcer, and cardiovascular symptoms) were associated with a statistically significant weekend effect. None of the 50 diagnoses demonstrated a statistically significant reduction in mortality for weekend admissions as compared with weekday admissions. Mortality was similar among patients admitted to major (odds ratio [OR] = 1.06; 95% CI: 0.94 to 1.19) and minor (OR = 1.03; 95% CI: 0.97 to 1.09) teaching hospitals, compared with nonteaching hospitals. However, the weekend effect was larger in major teaching hospitals compared with nonteaching hospitals (OR =1.13 vs. 1.03, P = 0.03) and minor teaching hospitals (OR = 1.05, P = 0.11).

Conclusion

Patients admitted to hospitals on weekends experienced slightly higher risk-adjusted mortality than did patients admitted on weekdays. While overall mortality was similar for patients admitted to all hospital categories, the weekend effect was larger in major teaching hospitals and is cause for concern.

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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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.

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