Special articleWaiting for urgent procedures on the weekend among emergently hospitalized patients☆
Section snippets
Procedure selection
We selected six procedures that reflect diverse technologies regularly employed in acute care hospitals: fiberoptic bronchoscopy, esophageal gastroduodenoscopy, magnetic resonance imaging, echocardiography, ventilation-perfusion scanning, and coronary angiography 18, 19. Performance of these procedures involves some degree of specialized skill and, from our clinical experience, can be associated with substantial in-hospital waits.
Patient selection
We identified consecutive patients admitted to all 190 acute care
Results
Overall, 3,789,917 emergency patients were admitted to the hospital, of whom 126,754 had one of the six selected procedures as their most responsible procedure during the hospital stay, reflecting about 1 patient for every 30 admissions (Table 1). Esophageal gastroduodenoscopy was the most common procedure performed (n = 45,167) and fiberoptic bronchoscopy was the least common procedure (n = 3973) (Table 2).
An equal spread of procedure performance during the week would predict a 2/7 (29%) to
Discussion
We examined six procedures often needed for emergently hospitalized patients and found that the overwhelming majority of these procedures were performed on weekdays. The day a patient was admitted to hospital affected the wait until procedure performance, but the differences between weekend and weekday waits were not large on average. The longest waits were not limited to patients admitted on the weekend. In fact, Friday admission was associated with the longest procedural waits.
While the
Acknowledgements
We thank Alex Kopp for help with computer programming. We are also grateful to Drs. Ross Baker, Allan Detsky, Ed Etchells, Claudio Martin, Art Slutsky, and Jack Tu for comments on drafts of this manuscript.
References (51)
- et al.
Reducing lengths of stay for patients hospitalized with chest pain using medical practice guidelines and opinion leaders
Am J Cardiol
(1993) - et al.
Projected cost-effectiveness of primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(1997) - et al.
Initial cost of primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(1996) - et al.
Accuracy of administrative data for assessing outcomes after knee replacement surgery
J Clin Epidemiol
(1997) - et al.
Waiting for coronary artery bypass surgeryPopulation-based study of 8517 consecutive patients in ontario, canada. the steering committee of the adult cardiac care network of ontario
Lancet
(1995) - et al.
Three years' experience with an all-digital nuclear medicine department
Semin Nucl Med
(1990) - et al.
Emergency department coverage by academic departments of radiology
Acad Radiol
(2000) - et al.
Nonvascular interventional proceduresAnalysis of a 10-year database containing more than 21,000 cases
Radiology
(2001) Hospital saves by working weekends
Mod Healthcare
(1996)- et al.
Expanding weekend and holiday clinical servicesA financial perspective
Healthc Financ Manage
(1998)
The epidemiology of delays in a teaching hospital. The development and use of a tool that detects unnecessary hospital days
Med Care
Waiting timesMonitoring the total postreferral wait
BMJ
Predictors of inappropriate hospital days in a department of internal medicine
Int J Epidemiol
Inappropriate use of hospital bedsA case study of university hospitals in turkey
World Hosp Health Serv
Is cardiac test availability a significant factor in weekend delays in discharge for chest pain patients?
J Gen Intern Med
Determinants of resource utilization for patients admitted for evaluation of acute chest pain
J Gen Intern Med
Cutting the cost of emergency surgical admissions
Ann R Coll Surg Engl
In-hospital cost of percutaneous coronary revascularization. Critical determinants and implications
Circulation
Length-of-stay variations within ICDA-8 diagnosis-related groups
Med Care
Mortality among patients admitted to hospitals on weekends as compared with weekdays
N Engl J Med
Why do hospital death rates vary?
N Engl J Med
Physicians' views of the relative importance of thirty medical innovations
Health Aff (Millwood)
Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures
A summary of studies on the quality of health care administrative databases in Canada
Inventory of Studies on the Accuracy of Canadian Health Administrative Databases
Cited by (125)
Laparoscopic Appendectomy and Cholecystectomy Timing Predicts Hand-Offs but Not Miscounts
2022, Journal of Surgical ResearchImpact of Off-Hour Admission with Subarachnoid Hemorrhage: A Meta-Analysis
2022, World NeurosurgeryChallenging weekend discharges associated with excess length of stay in surgical patients at Veterans Affairs hospitals
2022, Surgery (United States)Citation Excerpt :There are many possible reasons why discharges may be delayed over the weekend. Variations in staffing over the weekend have been associated with the “weekend effect”—worse outcomes in patients with admissions or operations over the weekend—owing to delays in procedures and limitations in hospital services.5,8–11 A study of medical patients demonstrated that improved continuity of care over the weekend was associated with increased weekend discharges and shorter LOS,2 suggesting that there are modifiable factors that can facilitate discharge over the weekend.
The weekday effect on postoperative mortality in elective abdominal surgery: An observational study using propensity score methods
2021, Surgery (United States)Citation Excerpt :Several studies have shown that reduced staffing levels during the weekend may be a factor for the higher mortality in patients operated or admitted on a weekend.2,3 Other reports have found that increased mortality is related to the decreased availability of therapeutic and diagnostic services, such as endoscopies for emergency gastrointestinal bleeding.22−27 Similarly, there are also some differences in resources available in the weekend compared with those on a weekday at our center.
Did the introduction of comprehensive stroke centers impact the “weekend effect” on mortality for patients with intracranial hemorrhage in the United State?
2019, Clinical Neurology and Neurosurgery
- ☆
Dr. Bell is funded by a Clinician-Scientist Award from the Canadian Institutes of Health Research. Dr. Redelmeier is funded by a Career Scientist Award from the Ontario Ministry of Health and the deSouza Chair in Clinical Trauma Research of the University of Toronto.