Clinical research study
Complication Rates on Weekends and Weekdays in US Hospitals

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Abstract

Purpose

Recent studies and anecdotal evidence suggest that patient safety may be compromised on weekends. Our objective was to determine whether rates of complications in hospitals are higher on weekends than on weekdays.

Methods

We examined records from 4,967,114 admissions to acute care hospitals in 3 states and analyzed complication rates using the Patient Safety Indicators. We selected 8 indicators that could be assigned to a single day: complications of anesthesia, retained foreign bodies, postoperative hemorrhage, accidental cuts and lacerations during procedures, birth trauma, obstetric trauma during vaginal deliveries with and without instrumentation, and obstetric trauma during cesarean delivery. Odds ratios (ORs) comparing weekends versus weekdays were adjusted for demographics, type of admission, and admission route. In a subgroup analysis of surgical complications, we restricted the population to patients who underwent cardiac or vascular procedures.

Results

Four of the 8 complications occurred more frequently on weekends: postoperative hemorrhage (OR 1.07, 95% confidence interval [CI], 1.01-1.14), newborn trauma (OR 1.06, 95% CI, 1.03-1.10), vaginal deliveries without instrumentation (OR 1.03, 95% CI, 1.02-1.04), and obstetric trauma during cesarean sections (OR 1.36, 95% CI, 1.29-1.44). Complications related to anesthesia occurred less frequently on weekends (OR 0.86). Among patients undergoing vascular procedures, surgical complications occurred more frequently on weekends (OR 1.46, 95% CI, 1.16-1.85).

Conclusions

Rates of complications are marginally higher on weekends than on weekdays for some surgical and newborn complications, but more significantly for obstetric trauma and for surgical complications involving patients undergoing vascular procedures. Hospitals should work toward increasing the robustness of safeguards on weekends.

Section snippets

Data Sources

We collected state administrative inpatient data from 1999 to 2001 for New York and Massachusetts, and from 2000 to 2001 for North Carolina. The data were obtained from the Healthcare Utilization Project’s State Inpatient Databases, which are a compilation of data from participating states containing the universe of those states’ nonfederal hospital discharge abstracts.15 These databases have been used extensively in health services and outcomes research.15, 16, 17, 18 They contain standardized

Characteristics of the Population

We collected data on 4,967,114 admissions of patients at risk for at least 1 of the 8 study complications during our study period. The baseline characteristics of patients who were at risk for a complication on weekends compared with weekdays are shown in Table 2. Patients admitted on weekends constituted 14.8% of the total number of admissions and, on average, were younger and less likely to be white. Table 3 shows the distribution of complications by type and state. We detected 114,090

Discussion

This study aimed to add to the existing debate about the safety of hospital care on weekends by looking at specific complications rather than mortality. We analyzed data from approximately 5 million hospital admissions in 3 states and found small but significantly increased rates of several types of complications on weekends for surgical, newborn, and obstetric patients. We also found complications related to anesthesia occurred less frequently on weekends, and 3 complications for which there

Conclusion

We present evidence that weekend care affects the rates of few complications in acute care hospitals. This increase is mostly small but pronounced for cesarean sections and vascular procedures. We believe it may be explained by hospital staffing structures and resource use. However, although changes to these underlying issues occur slowly, hospitals and some health care providers should be aware of the increased weekend rates of complications and take steps to improve patient safety.

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