Analysis of the Mortality of Patients Admitted to Internal Medicine Wards Over the Weekend

Abstract

The management of patients admitted during weekends may be compromised because the level of staffing in the hospital is often lower then. This study was conducted to assess what independent influence, if any, weekend admission might have on inhospital mortality. The authors analyzed the clinical data of 429 880 adults >" xbd="1605" xhg="1582" ybd="1190" yhg="1154"/>14 years of age who were admitted to internal medicine wards in Spain after having presented to the hospitals’ emergency departments. Overall mortality and early mortality (occurring in the first 48 hours) were examined, taking into account whether a patient was admitted on a weekend or a weekday, in addition to other parameters. Weekend admissions were associated with a significantly higher inhospital mortality than weekday admissions among patients admitted to an internal medicine service (odds ratio [OR] = 1.1; 95% confidence interval [CI] = 1.14-1.08). Differences in mortality persisted after adjustment for age, sex, and coexisting disorders (OR = 1.071; 95% CI = 1.046-1.097). Analyses of deaths within 2 days after admission showed larger relative differences in mortality between weekend and weekday admissions (OR = 1.28; 95% CI = 1.22-1.33). For patients admitted to an internal medicine service via an acute care visit to the emergency room, admission on weekends is associated with higher mortality than admission during the week.

Keywords

mortality weekends internal medicine

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References

Barba R. , Losa JE , Velasco M. , Guijarro C. , Garcia dC , Zapatero A. Mortality among adult patients admitted to the hospital on weekends. Eur J Intern Med. 2006;17: 322-324.

Bell CM , Redelmeier DA Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001;345:663-668.

Cram P. , Hillis SL , Barnett M. , Rosenthal GE Effects of weekend admission and hospital teaching status on in-hospital mortality . Am J Med. 2004;117:151-157.

Gogel HK Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2002;346:1500-1501.

Kostis WJ , Demissie K. , Marcella SW , Shao YH , Wilson AC , Moreyra AE Weekend versus weekday admission and mortality from myocardial infarction . N Engl J Med. 2007;356:1099-1109.

Peberdy MA , Ornato JP , Larkin GL , et al. Survival from inhospital cardiac arrest during nights and weekends . JAMA. 2008;299:785-792.

Redelmeier DA , Bell CM Weekend worriers. N Engl J Med. 2007;356:1164-1165.

Saposnik G. , Baibergenova A. , Bayer N. , Hachinski V. Weekends: a dangerous time for having a stroke? Stroke. 2007;38:1211-1215.

Schmulewitz L. , Proudfoot A. , Bell D. The impact of weekends on outcomes for emergency patients. Clin Med. 2005; 5:621-625.

10.

Hasegawa Y. , Yoneda Y. , Okuda S. , et al. The effect of weekends and holidays on stroke outcome in acute stroke units. Cerebrovasc Dis. 2005;20:325-331.

11.

Becker DJ Do hospitals provide lower quality care on weekends? Health Serv Res. 2007;42:1589-1612.

12.

Ensminger SA , Morales IJ , Peters SG , et al. The hospital mortality of patients admitted to the ICU on weekends. Chest. 2004 ;126:1292-1298.

13.

Luyt CE , Combes A. , Aegerter P. , et al. Mortality among patients admitted to intensive care units during weekday day shifts compared with "off" hours. Crit Care Med . 2007;35:3-11.

14.

Arabi Y. , Alshimemeri A. , Taher S. Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage. Crit Care Med. 2006;34:605-611.

15.

Gould JB , Qin C. , Marks AR , Chavez G. Neonatal mortality in weekend vs weekday births. JAMA. 2003;289:2958-2962.

16.

Heller G. , Schnell R. , Misselwitz B. , Schmidt S. Risk of neonatal death on weekends vs weekdays. JAMA. 2003;290:2125-2126.

17.

Zapatero A. , Barba R. Altas Atendias en Medicina Interna en los Hospitales Generales del Sistema Nacional de Salud. Madrid, Spain: FEMI; 2008.

18.

Charlson ME , Pompei P. , Ales KL , MacKenzie CR A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-383.

19.

Deyo RA , Cherkin DC , Ciol MA Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613-619.

20.

Bell CM , Redelmeier DA Waiting for urgent procedures on the weekend among emergently hospitalized patients. Am J Med. 2004;117:175-181.

21.

Bendavid E. , Kaganova Y. , Needleman J. , Gruenberg L. , Weissman JS Complication rates on weekends and weekdays in US hospitals. Am J Med. 2007;120:422-428.

22.

Laks MP , Rotblat M. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2002;346:1500-1501.

23.

Holmberg L. Professional or administrative value patterns? Clinical pathways in medical problem-solving processes. Health Serv Manage Res. 2007;20:238-243.

24.

Lee KH , Anderson YM The association between clinical pathways and hospital length of stay: a case study. J Med Syst. 2007;31:79-83.

25.

Bonfill X. , Marzo M. Guías de Práctica Clínica: Tenerlas, que sean de calidad y que salgan del armario. Med Clin (Barc ). 2003;120:496-497.

26.

Borman E. Promoting good medical care. Eur J Intern Med. 2004;15:540-545.

27.

Baroletti S. , Munz K. , Sonis J. , et al. Electronic alerts for hospitalized high-VTE risk patients not receiving prophylaxis: a cohort study. J Thromb Thrombolysis . 2008;25:146-150.

28.

Burkle T. , Baur T. , Hoss N. Clinical pathways development and computer support in the EPR: lessons learned . Stud Health Technol Inform. 2006;124:1025-1030.

29.

Kucher N. , Koo S. , Quiroz R. , et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005;352:969-977.

30.

Amarasingham R. , Plantinga L. , Diener-West M. , Gaskin DJ , Powe NR Clinical information technologies and inpatient outcomes. Arch Intern Med. 2009;169:108-114.