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Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital
  1. Lu Han1,
  2. Matt Sutton2,
  3. Stuart Clough3,
  4. Richard Warner4,
  5. Tim Doran1
  1. 1 Department of Health Sciences, University of York, York, UK
  2. 2 Manchester Centre for Health Economics, University of Manchester, Manchester, UK
  3. 3 Haelo, Salford, UK
  4. 4 Salford Royal Foundation Trust, Salford, UK
  1. Correspondence to Dr Lu Han, Department of Health Sciences, University of York, York, YO10 5DD, UK; l.han{at}york.ac.uk

Abstract

Background Emergency hospital admission on weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day—not time—of admission. We used an enhanced longitudinal data set to estimate the ‘weekend effect’ over time and the effect of night-time admission on all-cause mortality rates.

Methods We examined 246 350 emergency spells from a large teaching hospital in England between April 2004 and March 2014. Outcomes included 7-day, 30-day and in-hospital mortality rates. We conducted probit regressions to estimate the impact on the absolute difference in the risk of mortality of two key predictors: (1) admission on weekends (19:00 Friday to 06:59 Monday); and (2) night-time admission (19:00 to 06:59). Logistic regressions were used to estimate ORs for relative mortality risk differences.

Results Crude 30-day mortality rate decreased from 6.6% in 2004/2005 to 5.2% in 2013/2014. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission on weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.17, 95% CI 1.10 to 1.25), 7-day mortality by 0.5 percentage points (adjusted OR: 1.23, 95% CI 1.12 to 1.34) and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.14, 95% CI 1.08 to 1.21) compared with admission on weekday daytimes. Weekend night-time admission was associated with increased mortality risk in 9 out of 10 years, but this was only statistically significant (p<0.05) in 5 out of 10 years.

Conclusions There is an increased risk of mortality for patients admitted as emergencies both on weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night on weekends. This increased risk appears to be consistent over time, but the effects are small and are not statistically significant in individual hospitals in every year.

  • health services research
  • healthcare quality improvement
  • patient safety
  • statistics

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors LH codesigned the study, conducted statistical analyses, interpreted the results and led the writing of the paper. MS and TD codesigned the study, advised on data analyses, contributed to the interpretation of the results and provided critical review of the paper. SC extracted the data set from Salford Royal Foundation Trust, with significant contribution to the review of the paper. RW provided clinical and institutional advice for the result interpretation and contributed to the review of the paper. All authors have approved the final version of the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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