RT Journal Article
SR Electronic
T1 Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 223
OP 230
DO 10.1136/bmjqs-2018-008219
VO 28
IS 3
A1 Jianxia Sun
A1 Alan J Girling
A1 Cassie Aldridge
A1 Felicity Evison
A1 Chris Beet
A1 Amunpreet Boyal
A1 Gavin Rudge
A1 Richard J Lilford
A1 Julian Bion
YR 2019
UL http://qualitysafety.bmj.com/content/28/3/223.abstract
AB Objective To determine whether the higher weekend admission mortality risk is attributable to increased severity of illness.Design Retrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England.Outcome measures 30-day postadmission weekend:weekday mortality ratios adjusted for severity of illness (baseline National Early Warning Score (NEWS)), routes of admission to hospital, transfer to the intensive care unit (ICU) and demographics.Results Despite similar emergency department daily attendance rates, fewer patients were admitted on weekends (mean admission rate 91/day vs 120/day) because of fewer general practitioner referrals. Weekend admissions were sicker than weekday (mean NEWS 1.8 vs 1.7, p=0.008), more likely to undergo transfer to ICU within 24 hours (4.2% vs 3.0%), spent longer in hospital (median 3 days vs 2 days) and less likely to experience same-day discharge (17.2% vs 21.9%) (all p values <0.001).The crude 30-day postadmission mortality ratio for weekend admission (OR=1.13; 95% CI 1.08 to 1.19) was attenuated using standard adjustment (OR=1.11; 95% CI 1.05 to 1.17). In patients for whom NEWS values were available (90%), the crude OR (1.07; 95% CI 1.01 to 1.13) was not affected with standard adjustment. Adjustment using NEWS alone nullified the weekend effect (OR=1.02; 0.96–1.08).NEWS completion rates were higher on weekends (91.7%) than weekdays (89.5%). Missing NEWS was associated with direct transfer to intensive care bypassing electronic data capture. Missing NEWS in non-ICU weekend patients was associated with a higher mortality and fewer same-day discharges than weekdays.Conclusions Patients admitted to hospital on weekends are sicker than those admitted on weekdays. The cause of the weekend effect may lie in community services.