101
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Staib A, Sullivan C, Jones M, Griffin B, Bell A, Scott I. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital. Emerg Med Australas 2016; 29:363-366. [PMID: 27592365 DOI: 10.1111/1742-6723.12661] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/27/2022]
Abstract
Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes.
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Affiliation(s)
- Andrew Staib
- Emergency Medicine, Princess Alexandra Hospital, Metro South Health, MMRI University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Clair Sullivan
- Emergency Medicine, Princess Alexandra Hospital, Metro South Health, MMRI University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Matt Jones
- Metro South Digital Hospital Program, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian Scott
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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McCallum IJD, McLean RC, Dixon S, O'Loughlin P. Retrospective analysis of 30-day mortality for emergency general surgery admissions evaluating the weekend effect. Br J Surg 2016; 103:1557-65. [DOI: 10.1002/bjs.10261] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/05/2016] [Accepted: 06/06/2016] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The weekend effect describes excess mortality associated with hospital admission on Saturday or Sunday. This study assessed whether a weekend effect exists for patients admitted for emergency general surgery.
Methods
Data for emergency general surgical admissions to National Health Service hospitals in the Northern Deanery in England between 2000 and 2014 were collected, including demographics, co-morbidities, diagnoses, operations undertaken and outcomes. The primary outcome of interest was in-hospital death within 30 days of admission. Cox regression analysis was undertaken with adjustment for co-variables.
Results
There were 12 100 in-hospital deaths within 30 days of admission (3·3 per cent). The overall 30-day mortality rate reduced significantly during the 15-year interval studied, from 5·4 per cent (2000–2004) to 4·0 per cent (2005–2009) and 2·9 per cent during 2010–2014 (P < 0·001). There was no significant mortality difference for patients admitted at the weekend in adjusted Cox models (hazard ratio (HR) 1·00 for Saturday and 0·90 for Sunday, versus Wednesday). There was a significantly higher mortality for operations undertaken at the weekend (HR 1·15 for Saturday and 1·40 for Sunday; P = 0·021 and P < 0·001 respectively). The significantly increased mortality that was evident for emergency surgery at the weekend compared with weekdays in 2000–2004 (HR 1·46 for Saturday and 1·55 for Sunday; both P < 0·001); had reduced by 2010–2014, when the adjusted mortality risk was not significant (HR 1·18 for Saturday and 1·12 for Sunday).
Conclusion
During the past 15 years there has been a weekend effect in patients undergoing emergency general surgery based on day of operation, but not day of admission. Overall mortality for emergency general surgery has improved significantly, and in the past 5 years the increased mortality risk of weekend surgery has reduced.
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Affiliation(s)
- I J D McCallum
- Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK
| | - R C McLean
- Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK
| | - S Dixon
- Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK
| | - P O'Loughlin
- Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK
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Manfredini R, Gallerani M, Giorgi AD, Boari B, Lamberti N, Manfredini F, Storari A, Manna GL, Fabbian F. Lack of a “Weekend Effect” for Renal Transplant Recipients. Angiology 2016; 68:366-373. [DOI: 10.1177/0003319716660245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The “weekend (WE) effect” defines the association between WE hospital admissions and higher rate of mortality. The aim of this study was to evaluate the relationship between WE effect and renal transplant recipients (RTRs) using the database of the Emilia-Romagna region (ERR), Italy. We included ERR admissions of RTRs ( International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] code V420) between 2000 and 2013. In-hospital mortality, admissions due to cardiovascular events (CVEs), and the Elixhauser score were evaluated on the basis of ICD-9-CM codification. Out of 9063 hospital admissions related to 3648 RTRs (mean age 53 ± 13 years, 62.9% male), 1491 (16.5%) were recorded during the WE. During the follow-up period, 1581 (17.4%) patients deceased and 366 (4%) had CVEs. Length of hospital stay (LOS) was 9.7 ± 12.1 days. Logistic regression analysis showed that only LOS was independently associated with WE admissions (odds ratio: 1594, confidence interval: 1.385-1.833; P < .001). Renal transplant recipients are not exposed to higher risk of adverse outcome during WE admissions. However, WE admissions were characterized by an increased duration of hospitalization.
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Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Benedetta Boari
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Alda Storari
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
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Bray BD, Cloud GC, James MA, Hemingway H, Paley L, Stewart K, Tyrrell PJ, Wolfe CDA, Rudd AG. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. Lancet 2016; 388:170-7. [PMID: 27178477 DOI: 10.1016/s0140-6736(16)30443-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies in many health systems have shown evidence of poorer quality health care for patients admitted on weekends or overnight than for those admitted during the week (the so-called weekend effect). We postulated that variation in quality was dependent on not only day, but also time, of admission, and aimed to describe the pattern and magnitude of variation in the quality of acute stroke care across the entire week. METHODS We did this nationwide, registry-based, prospective cohort study using data from the Sentinel Stroke National Audit Programme. We included all adult patients (aged >16 years) admitted to hospital with acute stroke (ischaemic or primary intracerebral haemorrhage) in England and Wales between April 1, 2013, and March 31, 2014. Our outcome measure was 30 day post-admission survival. We estimated adjusted odds ratios for 13 indicators of acute stroke-care quality by fitting multilevel multivariable regression models across 42 4-h time periods per week. FINDINGS The study cohort comprised 74,307 patients with acute stroke admitted to 199 hospitals. Care quality varied across the entire week, not only between weekends and weekdays, with different quality measures showing different patterns and magnitudes of temporal variation. We identified four patterns of variation: a diurnal pattern (thrombolysis, brain scan within 12 h, brain scan within 1 h, dysphagia screening), a day of the week pattern (stroke physician assessment, nurse assessment, physiotherapy, occupational therapy, and assessment of communication and swallowing by a speech and language therapist), an off-hours pattern (door-to-needle time for thrombolysis), and a flow pattern whereby quality changed sequentially across days (stroke-unit admission within 4 h). The largest magnitude of variation was for door-to-needle time within 60 min (range in quality 35-66% [16/46-232/350]; coefficient of variation 18·2). There was no difference in 30 day survival between weekends and weekdays (adjusted odds ratio 1·03, 95% CI 0·95-1·13), but patients admitted overnight on weekdays had lower odds of survival (0·90, 0·82-0·99). INTERPRETATION The weekend effect is a simplification, and just one of several patterns of weekly variation occurring in the quality of stroke care. Weekly variation should be further investigated in other health-care settings, and quality improvement should focus on reducing temporal variation in quality and not only the weekend effect. FUNDING None.
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Affiliation(s)
- Benjamin D Bray
- Farr Institute of Health Informatics Research, University College London, London, UK.
| | | | | | - Harry Hemingway
- Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Kevin Stewart
- Clinical Effectiveness and Evaluation Unit, London, UK
| | - Pippa J Tyrrell
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Charles D A Wolfe
- Division of Health and Social Care Research, King's College London, London, UK
| | - Anthony G Rudd
- Division of Health and Social Care Research, King's College London, London, UK
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Aldridge C, Bion J, Boyal A, Chen YF, Clancy M, Evans T, Girling A, Lord J, Mannion R, Rees P, Roseveare C, Rudge G, Sun J, Tarrant C, Temple M, Watson S, Lilford R. Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. Lancet 2016; 388:178-86. [PMID: 27178476 PMCID: PMC4945602 DOI: 10.1016/s0140-6736(16)30442-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service. METHODS Eligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013-14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile. FINDINGS 127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34,350 clinicians surveyed, 15,537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40-58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients admitted at weekends was higher than among those admitted on weekdays (adjusted odds ratio 1·10, 95% CI 1·08-1·11; p<0·0001). There was no significant association between Sunday to Wednesday specialist intensity ratios and weekend to weekday mortality ratios (r -0·042; p=0·654). INTERPRETATION This cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions. Further investigation is needed to evaluate whole-system secular change during the implementation of 7 day services. Policy makers should exercise caution before attributing the weekend effect mainly to differences in specialist staffing. FUNDING National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
| | | | - Amunpreet Boyal
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Mike Clancy
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Tim Evans
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | | | | | - Peter Rees
- Academy of Medical Royal Colleges Patient Liaison Group, London, UK
| | | | | | - Jianxia Sun
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Mark Temple
- Heart of England NHS Foundation Trust, Birmingham, UK
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106
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Geng J, Ye X, Liu C, Xie J, Chen J, Xu B, Wang B. Outcomes of off- and on-hours admission in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A retrospective observational cohort study. Medicine (Baltimore) 2016; 95:e4093. [PMID: 27399103 PMCID: PMC5058832 DOI: 10.1097/md.0000000000004093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Studies evaluating the outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are scarce, particularly in China. The purpose of present study was therefore to compare the impact of off-hours and on-hours admission on clinical outcomes in STEMI patients from China.We retrospectively analyzed 1594 patients from 4 hospitals. Of these, 903 patients (56.65%) were admitted during off-hours (weekdays from 18:00 to 08:00, weekends and holidays) and 691 (43.35%) were during on-hours (weekdays from 08:00 to 18:00).Patients admitted during off-hours had higher thrombolysis in myocardial infarction risk score (4.67 ± 2.27 vs 4.39 ± 2.10, P = 0.012) and longer door-to-balloon time (72 [50-96] vs 64 [42-92] minutes, P < 0.001) than those admitted during on-hours. Off-hours admission had no association with in-hospital (unadjusted odds ratio 2.069, 95% confidence interval [CI] 0.956-4.480, P = 0.060) and long-term mortality (unadjusted hazards ratio [HR] 1.469, 95%CI 0.993-2.173, P = 0.054), even after adjustment for confounders. However, long-term outcomes, the composite of deaths and other adverse events, differed between groups with an unadjusted HR of 1.327 (95%CI, 1.102-1.599, P = 0.003), which remained significant in regression models. In a subgroup analysis, off-hours admission was associated with higher long-term mortality in the high-risk subgroup (unadjusted HR 1.965, 95%CI 1.103-3.512, P = 0.042), but not in low- and moderate-risk subgroups.This study showed no association between off-hours admission and in-hospital and long-term mortality. Stratified analysis indicated that off-hours admission was significantly associated with long-term mortality in the high-risk subgroup.
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Affiliation(s)
- Jin Geng
- Department of Cardiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing
- Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University, Huai’an
| | - Xiao Ye
- Department of Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou
| | - Chen Liu
- Department of Cardiology, Yangzhou No.1 People's hospital, Yangzhou, China
| | - Jun Xie
- Department of Cardiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing
| | - Jianzhou Chen
- Department of Cardiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing
| | - Biao Xu
- Department of Cardiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing
- Correspondence: Biao Xu, Department of Cardiology, Drum Tower Hospital, Nanjing Medical University, Nanjing, China (e-mail: ); Bingjian Wang, Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University, Huai’an, Jiangsu, China (e-mail: )
| | - Bingjian Wang
- Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University, Huai’an
- Correspondence: Biao Xu, Department of Cardiology, Drum Tower Hospital, Nanjing Medical University, Nanjing, China (e-mail: ); Bingjian Wang, Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University, Huai’an, Jiangsu, China (e-mail: )
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107
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Patel R, Chesney E, Cullen AE, Tulloch AD, Broadbent M, Stewart R, McGuire P. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital. Br J Psychiatry 2016; 209:29-34. [PMID: 27103681 PMCID: PMC4929405 DOI: 10.1192/bjp.bp.115.180307] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals. AIMS To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes. METHOD Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week. RESULTS There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient -21.1 days, 95% CI -24.6 to -17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. CONCLUSIONS Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.
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Affiliation(s)
- Rashmi Patel
- Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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108
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Ubayasiri KM, Daniel M. Does the weekend effect influence the length of stay in patients admitted with tonsillitis, quinsy and epistaxis? A review of 363 emergency admissions over a 12-month period. Clin Otolaryngol 2016; 42:768-772. [DOI: 10.1111/coa.12690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- K. M. Ubayasiri
- Otorhinolaryngology; Nottingham University Hospitals; Nottingham UK
| | - M. Daniel
- Otorhinolaryngology; Nottingham University Hospitals; Nottingham UK
- Otology and Hearing Research Group and NIHR Nottingham Hearing Biomedical Research Unit; The University of Nottingham; Nottingham UK
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109
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Singla AA, Guy GS, Field JBF, Ma N, Babidge WJ, Maddern GJ. Response to Re: No weak days? Impact of day in the week on surgical mortality. ANZ J Surg 2016; 86:523-4. [PMID: 27252138 DOI: 10.1111/ans.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Animesh A Singla
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Gordon S Guy
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - John B F Field
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Ning Ma
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Guy J Maddern
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
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110
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Baid-Agrawal S, Martus P, Feldman H, Kramer H. Weekend versus weekday transplant surgery and outcomes after kidney transplantation in the USA: a retrospective national database analysis. BMJ Open 2016; 6:e010482. [PMID: 27056590 PMCID: PMC4838691 DOI: 10.1136/bmjopen-2015-010482] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine whether kidney transplants performed during a weekend had worse outcomes than those performed during weekdays. DESIGN Retrospective national database study. SETTING United Network for Organ Sharing database of the USA. PARTICIPANTS 136,715 adult recipients of deceased donor single organ kidney transplants in the USA between 4/1994 and 9/2010. MAIN OUTCOME MEASURES The primary outcomes were patient survival and death-censored and overall allograft survival. Secondary outcomes included initial length of hospital stay after transplantation, delayed allograft function, acute rejection within the first year of transplant, and patient and allograft survival at 1 month and at 1 year after transplantation. Cox proportional hazards models were used to evaluate the impact of weekend kidney transplant surgery on primary and secondary outcomes, adjusting for multiple covariates. RESULTS Among the 136,715 kidney recipients, 72.5% underwent transplantation during a regular weekday (Monday-Friday) and 27.5% during a weekend (Saturday-Sunday). No significant association was noted between weekend transplant status and patient survival, death-censored allograft survival or overall allograft survival in the adjusted analyses (HR 1.01 (95% CI 0.92 to 1.04), 1.012 (95% CI 0.99 to 1.034), 1.012 (95% CI 0.984 to 1.04), respectively). In addition, no significant association was noted between weekend transplant status and the secondary outcomes of patient and graft survival at 1 month and 1 year, delayed allograft function or acute rejection within the first year. Results remained consistent across all definitions of weekend status. CONCLUSIONS The outcomes for deceased donor kidney transplantation in the USA are not affected by the day of surgery. The operationalisation of deceased donor kidney transplantation may provide a model for other surgeries or emergency procedures that occur over the weekend, and may help reduce length of hospital stay and improve outcomes.
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Affiliation(s)
- Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Clinic of Tuebingen, Tuebingen, Germany
| | - Harold Feldman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | - Holly Kramer
- Department of Public Health Sciences and Medicine, Division of Nephrology and Hypertension, Loyola Medical Center, Maywood, Illinois, USA
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111
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Warburton KG. Training the generals of the future. Future Hosp J 2016; 3:77-79. [PMID: 31098188 PMCID: PMC6465853 DOI: 10.7861/futurehosp.3-1-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Future Hospital Commission acknowledges that the principal challenge for healthcare organisations and professionals is to accept the fundamental requirement that patients must be treated with compassion, kindness and respect while having their physical and emotional needs met at all times. The recognition that clinical outcomes alone are an insufficient guide to the adequacy of health service provision demands cultural, organisational and individual change. In the Future Hospital Forum we scan the world literature for papers on systems of care that might best ensure these principles are delivered, and to critically evaluate their potential impact. The theme in this edition is generalism.
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112
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Affiliation(s)
- Rahul Potluri
- Founder of ACALM Study Unit and Clinical Lecturer, Aston Medical School, Aston University, Birmingham, B4 7ET, UK
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113
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Robinson EJ, Smith GB, Power GS, Harrison DA, Nolan J, Soar J, Spearpoint K, Gwinnutt C, Rowan KM. Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study. BMJ Qual Saf 2015; 25:832-841. [PMID: 26658774 PMCID: PMC5136724 DOI: 10.1136/bmjqs-2015-004223] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 10/27/2015] [Accepted: 11/09/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. OBJECTIVE To describe IHCA demographics during three day/time periods-weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)-and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. METHODS We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. RESULTS Risk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. CONCLUSIONS IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible.
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Affiliation(s)
| | - Gary B Smith
- Faculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK
| | | | | | - Jerry Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Jasmeet Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Ken Spearpoint
- Resuscitation Department, Imperial College Healthcare NHS Trust, London, UK
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Hodgson H. Smoke and mirrors. Clin Med (Lond) 2015; 15:507-8. [PMID: 26621934 PMCID: PMC4953247 DOI: 10.7861/clinmedicine.15-6-507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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115
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Lilford RJ, Chen YF. The ubiquitous weekend effect: moving past proving it exists to clarifying what causes it. BMJ Qual Saf 2015; 24:480-2. [DOI: 10.1136/bmjqs-2015-004360] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 11/03/2022]
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