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Liu D, Wang C, Li JK, Liu MY, Guo RZ, Liu MN. Effect of admission time of arrival on quality of in-hospital care in acute ischemic stroke patients in China. Public Health 2024; 234:126-131. [PMID: 38981376 DOI: 10.1016/j.puhe.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 05/10/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES The quality of care for patients may be partly determined by the time they are admitted to the hospital. This study was conducted to explore the effect of admission time and describe the pattern and magnitude of weekly variation in the quality of patient care. STUDY DESIGN A retrospective observational study. METHODS Data were collected from the Medical Care Quality Management and Control System for Specific (Single) Diseases in China. A total of 238,122 patients treated for acute ischemic stroke between January 2015 and December 2017 were included. The primary outcomes were completion of the ten process indicators and in-hospital death. RESULTS The quality of in-hospital care varied according to hospital arrival time. We identified several patterns of variation across the days of the week. In the first pattern, the quality of four indicators, such as stroke physicians within 15 min, was lowest for arrivals between 08:00 and 11:59, increased throughout the day, and peaked for arrivals between 20:00 and 23:59 or 00:00 and 03:59. In the second pattern, the quality of four indicators, such as the application of antiplatelet therapy within 48 h, was not significantly different between days and weeks. There was no difference in in-hospital mortality between the different admission times. CONCLUSIONS The effect of admission time on the quality of in-hospital care of patients with acute ischemic stroke showed several diurnal patterns. Detecting the times when quality is relatively low may lead to quality improvements in health care. Quality improvement should also focus on reducing diurnal temporal variation.
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Affiliation(s)
- D Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - C Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - J K Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - M Y Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - R Z Guo
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - M N Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China.
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Leivas PHS, Triaca LM, Santos AMAD, Jacinto PDA, Tejada CAO. Are heart attacks deadlier on weekends? Evidence of weekend effect in Brazil. CIENCIA & SAUDE COLETIVA 2024; 29:e03892023. [PMID: 39140529 DOI: 10.1590/1413-81232024298.03892023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/28/2023] [Indexed: 08/15/2024] Open
Abstract
This article aims to examine the effects of weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in Brazil. Information from the Hospital Information System of the Unified Health System (SIH/SUS) of urgently admitted patients diagnosed with acute myocardial infarction (AMI) between 2008 and 2018 was used, made available through the Hospital Admission Authorization (AIH). Multivariable logistic regression models, controlling for observable patient characteristics, hospital characteristics and year and hospital-fixed effects, were used. The results were consistent with the existence of the weekend effect. For the model adjusted with the inclusion of all controls, the chance of death observed for individuals hospitalized on the weekend is 14% higher. Our results indicated that there is probably an important variation in the quality of hospital care depending on the day the patient is hospitalized. Weekend admissions were associated with in-hospital AMI mortality in Brazil. Future research should analyze the possible channels behind the weekend effect to support public policies that can effectively make healthcare equitable.
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Affiliation(s)
- Pedro Henrique Soares Leivas
- Programa de Pós-Graduação em Economia Aplicada, Fundação Universidade Federal do Rio Grande. Av. Itália km 8. 96203-900 Rio Grande RS Brasil.
| | - Lívia Madeira Triaca
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas. Pelotas RS Brasil
| | | | - Paulo de Andrade Jacinto
- Programa de Pós-Graduação em Desenvolvimento Econômico, Universidade Federal do Paraná. Curitiba PR Brasil
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Rai K, Douglas IS, Mehta AB. Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study. J Intensive Care Med 2023; 38:1136-1142. [PMID: 37357730 DOI: 10.1177/08850666231185315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
RATIONALE Increased mortality in patients admitted to hospitals on weekends is a well-described phenomenon labeled the "weekend effect." Studies evaluating the weekend effect in intensive care units (ICUs) have arrived at conflicting results. Identifying a weekend effect for critically-ill patients may inform clinical care pathways and resource allocation. OBJECTIVES Determine the association of initiation of mechanical ventilation (MV) upon admission on a weekend versus weekday with hospital mortality. METHODS We conducted a retrospective cohort study of non-surgical adult patients using the California Patient Discharge Database from 2018 to 2019. We identified MV initiated on the day of admission and diagnoses using discharge billing codes. The primary exposure was admission and initiation of MV on a weekend versus weekday and the primary outcome was hospital mortality. Hierarchical logistic regression was used to determine the association between hospital mortality and MV initiation timing, adjusting for case-mix. RESULTS Among 90 288 admissions in 2018 and 2019 meeting inclusion criteria, 24 771 (27.5%) had MV initiated on weekends, while 65 517 (72.6%) had MV initiated on weekdays. Patient demographics and comorbidities were similar between groups. Chronic alcohol and substance use disorders, and acute intoxications and traumas were more prevalent among patients with MV initiated on weekends. No difference in hospital mortality was observed with initiation of MV on weekends versus weekdays (23.1% vs 22.8%, ARD = 0.3%, aOR = 1.02, 95% CI 0.98, 1.07). CONCLUSIONS Contrary to prior studies, no increased mortality was observed among newly admitted patients initiated on MV on weekends compared to weekdays. While weekend effects may exist in other settings, newly admitted patients likely have MV initiated in the emergency department or ICU, which tend to have more consistent staffing levels. Further research is needed to determine if care patterns in these units could be used as a model for units where weekend effects continue to impact outcomes.
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Affiliation(s)
- Karan Rai
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ivor S Douglas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anuj B Mehta
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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4
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Sylivris A, Ramson DM, Penny-Dimri JC, Liu Z, Perry LA, Au J, Yang Z, Park B, Pitesa R, Singh S, Smith JA, Taneja A, Eglinton T, Welsh F, Koea J, MacCormick AD, Barazanchi A, Hill AG. Weekend effect in emergency laparotomy: a propensity score-matched analysis. ANZ J Surg 2023; 93:1806-1810. [PMID: 37420316 DOI: 10.1111/ans.18595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The 'weekend effect' is the term given to the observed discrepancy regarding patient care and outcomes on weekends compared to weekdays. This study aimed to determine whether the weekend effect exists within Aotearoa New Zealand (AoNZ) for patients undergoing emergency laparotomy (EL), given recent advances in management of EL patients. METHODS A cohort study was conducted across five hospitals, comparing the outcomes of weekend and weekday acute EL. A propensity-score matched analysis was used to remove potential confounding patient characteristics. RESULTS Of the 487 patients included, 132 received EL over the weekend. There was no statistically significant difference between patients undergoing EL over the weekend compared to weekdays. Mortality rates were comparable between the weekday and weekend cohorts (P = 0.464). CONCLUSIONS These results suggest that modern perioperative care practice in New Zealand obviates the 'weekend' effect.
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Affiliation(s)
- Amy Sylivris
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Dhruvesh M Ramson
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | | | - Zhengyang Liu
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Luke A Perry
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Jessica Au
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Zoe Yang
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Brittany Park
- Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Renato Pitesa
- Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Surya Singh
- Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Julian A Smith
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Ashish Taneja
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Tim Eglinton
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Fraser Welsh
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Ahmed Barazanchi
- Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
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Lévy L, Robine JM, Rey G, Méndez Turrubiates RF, Quijal-Zamorano M, Achebak H, Ballester J, Rodó X, Herrmann FR. Daylight saving time affects European mortality patterns. Nat Commun 2022; 13:6906. [PMID: 36372798 PMCID: PMC9659560 DOI: 10.1038/s41467-022-34704-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/03/2022] [Indexed: 11/15/2022] Open
Abstract
Daylight saving time (DST) consists in a one-hour advancement of legal time in spring offset by a backward transition of the same magnitude in fall. It creates a minimal circadian misalignment that could disrupt sleep and homoeostasis in susceptible individuals and lead to an increased incidence of pathologies and accidents during the weeks immediately following both transitions. How this shift affects mortality dynamics on a large population scale remains, however, unknown. This study examines the impact of DST on all-cause mortality in 16 European countries for the period 1998-2012. It shows that mortality decreases in spring and increases in fall during the first two weeks following each DST transition. Moreover, the alignment of time data around DST transition dates revealed a septadian mortality pattern (lowest on Sundays, highest on Mondays) that persists all-year round, irrespective of seasonal variations, in men and women aged above 40.
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Affiliation(s)
- Laurent Lévy
- Medical School of the University of Geneva, Geneva, Switzerland
| | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
- École Pratique des Hautes Études, Paris, France
| | | | | | | | | | | | - Xavier Rodó
- ISGlobal, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain
| | - François R Herrmann
- Medical School of the University of Geneva, Geneva, Switzerland.
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland.
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Yuan X, Nienaber CA. Demystifying the Weekend Effect: What We Can Do to Avoid Deadly Weekends. JACC. ASIA 2022; 2:382-384. [PMID: 36338405 PMCID: PMC9627850 DOI: 10.1016/j.jacasi.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Christoph A. Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
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Correlation between surgical mortality for perforated peritonitis and days of the week for operations: A retrospective study using the Japanese National Clinical Database. Am J Surg 2022; 224:546-551. [PMID: 35210064 DOI: 10.1016/j.amjsurg.2022.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The association between weekend interventions and poor outcomes is termed the "weekend effect." This retrospective study investigated whether the weekend effect exists in the surgical treatment of acute diffuse peritonitis due to gastrointestinal perforation. METHODS Patients (n = 16,209) who underwent operation for acute diffuse peritonitis during 2016-2017 were included and grouped depending on the perforation site. Using 23 variables, we performed hierarchical logistic regression analysis and calculated odds ratios for surgical mortality. RESULTS Surgical mortality rates were 8.8%, 15.0%, and 14.1% for patients with gastroduodenal, small bowel, and large bowel perforations, respectively. Unadjusted odds ratios for surgical mortality differed significantly on Wednesdays only for patients with large bowel perforation (odds ratio: 0.772, 95% confidence interval: 0.613-0.972, P = 0.03). However, there was no significant difference in adjusted odds ratios. CONCLUSION The quality of emergency surgical treatment is uniform in Japan throughout the week in terms of mortality.
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8
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Weekend Mortality in an Italian Hospital: Immediate versus Delayed Bedside Critical Care Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020767. [PMID: 35055589 PMCID: PMC8776160 DOI: 10.3390/ijerph19020767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022]
Abstract
Background: a number of studies highlighted increased mortality associated with hospital admissions during weekends and holidays, the so–call “weekend effect”. In this retrospective study of mortality in an acute care public hospital in Italy between 2009 and 2015, we compared inpatient mortality before and after a major organizational change in 2012. The new model (Model 2) implied that the intensivist was available on call from outside the hospital during nighttime, weekends, and holidays. The previous model (Model 1) ensured the presence of the intensivist coordinating a Medical Emergency Team (MET) inside the hospital 24 h a day, 7 days a week. Methods: life status at discharge after 9298 and 8223 hospital admissions that occurred during two consecutive periods of 1185 days each (organizational Model 1 and 2), respectively, were classified into “discharged alive”, “deceased during nighttime–weekends–holidays” and “deceased during daytime-weekdays”. We estimated Relative Risk Ratios (RRR) for the associations between the organizational model and life status at discharge using multinomial logistic regression models adjusted for demographic and case-mix indicators, and timing of admission (nighttime–weekends–holidays vs. daytime-weekdays). Results: there were 802 and 840 deaths under Models 1 and 2, respectively. Total mortality was higher for hospital admissions under Model 2 compared to Model 1. Model 2 was associated with a significantly higher risk of death during nighttime–weekends–holidays (IRR: 1.38, 95% CI 1.20–1.59) compared to daytime–weekdays (RRR: 1.12, 95% CI 0.97–1.31) (p = 0.04). Respiratory diagnoses, in particular, acute and chronic respiratory failure (ICD 9 codes 510–519) were the leading causes of the mortality excess under Model 2. Conclusions: our data suggest that the immediate availability of an intensivist coordinating a MET 24 h, 7 days a week can result in a better prognosis of in-hospital emergencies compared to delayed consultation.
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Amigo F, Dalmau-Bueno A, García-Altés A. Do hospitals have a higher mortality rate on weekend admissions? An observational study to analyse weekend effect on urgent admissions to hospitals in Catalonia. BMJ Open 2021; 11:e047836. [PMID: 34845065 PMCID: PMC8634026 DOI: 10.1136/bmjopen-2020-047836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND 'Weekend effect' is a term used to describe the increased mortality associated with weekend emergency admissions to hospital, in contrast with admission on weekdays. The objective of the present study is to determine whether the weekend effect is present in hospitals in Catalonia. METHODS We analysed all urgent admissions in Catalonia in 2018, for a group of pathologies. Two groups were defined (those admitted on a weekday and those admitted on a weekend). We obtained mortality at 3, 7, 15 and 30 days, and applied a proportions test to both groups. Additionally, we used Cox's regression for mortality at 30 days, using the admission on a weekend as the exposition, adjusting by socioeconomic and clinical variables. We used the hospital discharge database and the Central Registry of the Insured Population. RESULTS 72 427 admissions for the selected pathologies during 2018 were found. No statistically significant differences in mortality at 30 days (p=0.524) or at 15 days (p=0.119) according to the day of admission were observed. However, significant differences were found in mortality at 7 days (p=0.025) and at 3 days (p=0.002). The hazard rate associated with the weekend was 1.13 (95% CI: 1.04 to 1.23). By contrast, the adjusted HR of the weekend interaction with time was 0.99 (95% CI: 0.99 to 1.00). CONCLUSIONS There is a weekend effect, but it is not constant in time. This could suggest the existence of dysfunctions in the quality of care during the weekend.
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Affiliation(s)
| | | | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain
- Fundacio Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Kato K, Otsuka T, Nakai M, Sumita Y, Seino Y, Kawada T. Effect of holiday admission for acute aortic dissection on in-hospital mortality in Japan: A nationwide study. PLoS One 2021; 16:e0260152. [PMID: 34793535 PMCID: PMC8601417 DOI: 10.1371/journal.pone.0260152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/03/2021] [Indexed: 01/16/2023] Open
Abstract
Background Patients admitted on weekends have higher mortality than those admitted on weekdays. However, whether the “weekend effect” results in a higher mortality after admission for acute aortic dissection (AAD),—classified according to Stanford types—remains unclear. This study aimed to examine the association between admission day and in-hospital mortality in AAD Type A and B. Methods We used data from the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination, a nationwide claim-based database with data from 953 certified hospitals, and enrolled in-patients with AAD admitted between April 1, 2012, and March 31, 2016. Based on the admission day, we stratified patients into groups (Weekdays, Saturdays, and Sundays/holidays). The influence of the admission day on in-hospital mortality was assessed via multi-level logistic regression analysis. We also performed a Stanford type-based stratified analysis. Results Among the included 25,641 patients, in-hospital mortality was 16.0%. The prevalence of patients admitted with AAD was relatively higher on weekdays. After adjustment for covariates, patients admitted on a Sunday/holiday showed an increased risk of in-hospital mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.07–1.33, p<0.001) than patients admitted on weekdays. Among patients admitted on a Sunday/holiday, only the subgroup of Stanford Type A showed a significantly increased risk of in-hospital mortality. (Stanford Type A, non-surgery vs. surgery groups: 95% CI 1.06–1.48 vs. 1.17–1.68, p<0.001 for both groups, OR 1.25 vs. 1.41, respectively, Stanford Type B, non-surgery vs. surgery groups: 95% CI 0.64–1.09 vs. 0.40–2.10; p = 0.182 vs. 0.846; OR 0.84 vs. 0.92). Conclusions In conclusion, patients with AAD Type A admitted on a Sunday/holiday may have an increased in-hospital mortality risk.
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Affiliation(s)
- Katsuhito Kato
- Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ko, Tokyo, Japan
- * E-mail:
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ko, Tokyo, Japan
| | - Michikazu Nakai
- Centre for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoko Sumita
- Centre for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Seino
- Cardiovascular Centre, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ko, Tokyo, Japan
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Xiong X, Wai AKC, Wong JYH, Tang EHM, Chu OCK, Wong CKH, Rainer TH. Impact of varying wave periods of COVID-19 on in-hospital mortality and length of stay for admission through emergency department: A territory-wide observational cohort study. Influenza Other Respir Viruses 2021; 16:193-203. [PMID: 34643047 PMCID: PMC8653231 DOI: 10.1111/irv.12919] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background The COVID‐19 pandemic has been associated with excess mortality and reduced emergency department attendance. However, the effect of varying wave periods of COVID‐19 on in‐hospital mortality and length of stay (LOS) for non‐COVID disease for non‐COVID diseases remains unexplored. Methods We examined a territory‐wide observational cohort of 563,680 emergency admissions between January 1 and November 30, 2020, and 709,583 emergency admissions during the same 2019 period in Hong Kong, China. Differences in 28‐day in‐hospital mortality risk and LOS due to COVID‐19 were evaluated. Results The cumulative incidence of 28‐day in‐hospital mortality increased overall from 2.9% in 2019 to 3.6% in 2020 (adjusted hazard ratio [aHR] = 1.22, 95% CI 1.20 to 1.25). The aHR was higher among patients with lower respiratory tract infection (aHR: 1.30 95% CI 1.26 to 1.34), airway disease (aHR: 1.35 95% CI 1.22 to 1.49), and mental disorders (aHR: 1.26 95% CI 1.15 to 1.37). Mortality risk in the first‐ and third‐wave periods was significantly greater than that in the inter‐wave period (p‐interaction < 0.001). The overall average LOS in the pandemic year was significantly shorter than that in 2019 (Mean difference = −0.40 days; 95% CI −0.43 to −0.36). Patients with mental disorders and cerebrovascular disease in 2020 had a 3.91‐day and 2.78‐day shorter LOS than those in 2019, respectively. Conclusions Increased risk of in‐hospital deaths was observed overall and by all major subgroups of disease during the pandemic period. Together with significantly reduced LOS for patients with mental disorders and cerebrovascular disease, this study shows the spillover effect of the COVID‐19 pandemic.
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Affiliation(s)
- Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Abraham K C Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.,Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China
| | - Janet Y H Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric H M Tang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Owen C K Chu
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Carlos K H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Timothy H Rainer
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.,Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China
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12
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Baig SH, Oxman DA, Yoo EJ. Weekend Admission Does Not Confer an Increased Risk of Mortality in Septic Shock. J Intensive Care Med 2021; 37:810-816. [PMID: 34459678 DOI: 10.1177/08850666211038549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To investigate the impact of weekend admission on mortality for patients with septic shock. Material and Methods: Retrospective cohort study of adults in the 2017 to 2018 National Inpatient Sample coded as R65.21 (severe sepsis with septic shock) within the first 3 diagnosis codes according to the 10th revision of the International Classification of Diseases. Measurements and Main Results: After exclusions, 100,584 records were analyzed (73,966 weekday and 26,618 weekend admissions). Severity-of-illness was estimated using the Charlson-Deyo comorbidity index. Using weighted logistic regression adjusted for factors identified on univariate analysis as potentially significant, we found no higher odds of death for weekday compared to weekend admissions (OR 1.00, 95% CI 0.99-1.02, P = .84). There was a temporal improvement in septic shock outcomes with 2018 admissions having lower odds of death (OR 0.97, 95% CI 0.96-0.98, P < .001). There was no evidence for interaction between weekend admission and individual years of admission (P = .17 and P = .05 for 2017 and 2018, respectively). However, weekend mortality did seem to vary by region in our interaction analysis with higher odds of death seen in the West (OR 1.08, 95% CI 1.05-1.11, P < .001). Conclusion: We found no evidence for higher mortality among patients admitted on weekends with septic shock.
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Affiliation(s)
- Saqib H Baig
- Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University and National Jewish Health, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - David A Oxman
- Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University and National Jewish Health, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Erika J Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University and National Jewish Health, Sidney Kimmel Medical College, Philadelphia, PA, USA
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Bion J, Aldridge C, Beet C, Boyal A, Chen YF, Clancy M, Girling A, Hofer T, Lord J, Mannion R, Rees P, Roseveare C, Rowan L, Rudge G, Sun J, Sutton E, Tarrant C, Temple M, Watson S, Willars J, Lilford R. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background
NHS England’s 7-day services policy comprised 10 standards to improve access to quality health care across all days of the week. Six standards targeted hospital specialists on the assumption that their absence caused the higher mortality associated with weekend hospital admission: the ‘weekend effect’. The High-intensity Specialist-Led Acute Care (HiSLAC) collaboration investigated this using the implementation of 7-day services as a ‘natural experiment’.
Objectives
The objectives were to determine whether or not increasing specialist intensity at weekends improves outcomes for patients undergoing emergency hospital admission, and to explore mechanisms and cost-effectiveness.
Design
This was a two-phase mixed-methods observational study. Year 1 focused on developing the methodology. Years 2–5 included longitudinal research using quantitative and qualitative methods, and health economics.
Methods
A Bayesian systematic literature review from 2000 to 2017 quantified the weekend effect. Specialist intensity measured over 5 years used self-reported annual point prevalence surveys of all specialists in English acute hospital trusts, expressed as the weekend-to-weekday ratio of specialist hours per 10 emergency admissions. Hospital Episode Statistics from 2007 to 2018 provided trends in weekend-to-weekday mortality ratios. Mechanisms for the weekend effect were explored qualitatively through focus groups and on-site observations by qualitative researchers, and a two-epoch case record review across 20 trusts. Case-mix differences were examined in a single trust. Health economics modelling estimated costs and outcomes associated with increased specialist provision.
Results
Of 141 acute trusts, 115 submitted data to the survey, and 20 contributed 4000 case records for review and participated in qualitative research (involving interviews, and observations using elements of an ethnographic approach). Emergency department attendances and admissions have increased every year, outstripping the increase in specialist numbers; numbers of beds and lengths of stay have decreased. The reduction in mortality has plateaued; the proportion of patients dying after discharge from hospital has increased. Specialist hours increased between 2012/13 and 2017/18. Weekend specialist intensity is half that of weekdays, but there is no relationship with admission mortality. Patients admitted on weekends are sicker (they have more comorbid disease and more of them require palliative care); adjustment for severity of acute illness annuls the weekend effect. In-hospital care processes are slightly more efficient at weekends; care quality (errors, adverse events, global quality) is as good at weekends as on weekdays and has improved with time. Qualitative researcher assessments of hospital weekend quality concurred with case record reviewers at trust level. General practitioner referrals at weekends are one-third of those during weekdays and have declined further with time.
Limitations
Observational research, variable survey response rates and subjective assessments of care quality were compensated for by using a difference-in-difference analysis over time.
Conclusions
Hospital care is improving. The weekend effect is associated with factors in the community that precede hospital admission. Post-discharge mortality is increasing. Policy-makers should focus their efforts on improving acute and emergency care on a ‘whole-system’ 7-day approach that integrates social, community and secondary health care.
Future work
Future work should evaluate the role of doctors in hospital and community emergency care and investigate pathways to emergency admission and quality of care following hospital discharge.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julian Bion
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Cassie Aldridge
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Chris Beet
- Intensive Care Medicine, Royal Derby Hospital NHS Trust, Derby, UK
| | - Amunpreet Boyal
- Research & Development, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Clancy
- Emergency Medicine, University of Southampton, Southampton, UK
| | - Alan Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Hofer
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Peter Rees
- Patient & Lay Committee, Academy of Medical Royal Colleges, London, UK
| | - Chris Roseveare
- General Internal Medicine, Southern Health NHS Foundation Trust, Southampton, UK
| | - Louise Rowan
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jianxia Sun
- Informatics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Mark Temple
- Nephrology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sam Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Janet Willars
- Health Sciences, University of Leicester, Leicester, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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14
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Off-hours admission does not impact outcomes in patients undergoing primary percutaneous coronary intervention and with a first medical contact-to-device time within 90 min. Chin Med J (Engl) 2021; 134:1795-1802. [PMID: 34172617 PMCID: PMC8367027 DOI: 10.1097/cm9.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: It remains unclear whether the outcomes of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) during off-hours are as favorable as those treated during on-hours, especially those with a first medical contact-to-device (FMC-to-device) time within 90 min. We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time ≤90 min. Methods: This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time ≤90 min from 19 chest pain centers in Beijing from January 2018 to December 2018. Patients were divided into on-hours group and off-hours group based on their arrival time. Baseline characteristics, clinical data, and key time intervals during treatment were collected from the Quality Control & Improvement Center of Cardiovascular Intervention of Beijing by the “Heart and Brain Green Channel” app. Results: Overall, the median age of the patients was 58.8 years and 19.9% (133/670) were female. Of these, 296 (44.2%) patients underwent PPCI during on-hours and 374 (55.8%) patients underwent PPCI during off-hours. Compared with the on-hours group, the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time ≤60 min (P < 0.05). During the mean follow-up period of 24 months, a total of 64 (9.6%) participants experienced a major adverse cardiovascular event (MACE), with 28 (9.1%) in the on-hours group and 36 (9.6%) in the off-hours group (P > 0.05). According to the Cox regression analyses, off-hours admission was not a predictor of 2-year MACEs (P = 0.788). Similarly, the Kaplan-Meier curves showed that the risks of a MACE, all-cause death, reinfarction, and target vessel revascularization were not significantly different between the two groups (P > 0.05). Conclusions: This real-world, multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min, off-hours admission was safe, with no difference in the risk of 2-year MACEs compared with those with on-hours admission.
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15
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Watson SI, Lilford RJ, Sun J, Bion J. Estimating the effect of health service delivery interventions on patient length of stay: A Bayesian survival analysis approach. J R Stat Soc Ser C Appl Stat 2021. [DOI: 10.1111/rssc.12501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Jianxia Sun
- University Hospitals Birmingham NHS Foundation Trust Birmingham UK
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16
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Birmpili P, Johal A, Li Q, Waton S, Chetter I, Boyle JR, Cromwell D. Factors associated with delays in revascularization in patients with chronic limb-threatening ischaemia: population-based cohort study. Br J Surg 2021; 108:951-959. [PMID: 33842943 DOI: 10.1093/bjs/znab039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/24/2020] [Accepted: 01/17/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Prompt revascularization in patients with chronic limb-threatening ischaemia (CLTI) is important, and recent guidance has suggested that patients should undergo revascularization within 5 days of an emergency admission to hospital. The aim of this cohort study was to identify factors associated with the ability of UK vascular services to meet this standard of care. METHODS Data on all patients admitted non-electively with CLTI who underwent open or endovascular revascularization between 2016 and 2019 were extracted from the National Vascular Registry. The primary outcome was interval between admission and procedure, analysed as a binary variable (5 days or less, over 5 days). Multivariable Poisson regression was used to examine the relationship between time to revascularization and patient and admission characteristics. RESULTS The study analysed information on 11 398 patients (5973 open, 5425 endovascular), 50.6 per of whom underwent revascularization within 5 days. The median interval between admission and intervention was 5 (i.q.r. 2-9) days. Patient factors associated with increased risk of delayed revascularization were older age, greater burden of co-morbidity, non-smoking status, presentation with infection and tissue loss, and a Fontaine score of IV. Patients admitted later in the week were less likely undergo revascularization within 5 days than those admitted on Sundays and Mondays (P < 0.001). Delays were slightly worse among patients having open compared with endovascular procedures (P = 0.005) and in hospitals with lower procedure volumes (P < 0.001). CONCLUSION Several factors were associated with delays in time to revascularization for patients with CLTI in the UK, most notably the weekday of admission, which reflects how services are organized. The results support arguments for vascular units providing revascularization to have the resources for a 7-day service.
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Affiliation(s)
- P Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Hull York Medical School, Hull, UK
| | - A Johal
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Q Li
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S Waton
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - I Chetter
- Hull York Medical School, Hull, UK.,Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - J R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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17
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Marang-van de Mheen PJ, Vincent C. Moving beyond the weekend effect: how can we best target interventions to improve patient care? BMJ Qual Saf 2021; 30:525-528. [PMID: 33574083 DOI: 10.1136/bmjqs-2020-012620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, London, UK
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18
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Bion J, Aldridge C, Girling AJ, Rudge G, Sun J, Tarrant C, Sutton E, Willars J, Beet C, Boyal A, Rees P, Roseveare C, Temple M, Watson SI, Chen YF, Clancy M, Rowan L, Lord J, Mannion R, Hofer T, Lilford R. Changes in weekend and weekday care quality of emergency medical admissions to 20 hospitals in England during implementation of the 7-day services national health policy. BMJ Qual Saf 2020; 30:536-546. [PMID: 33115851 PMCID: PMC8237174 DOI: 10.1136/bmjqs-2020-011165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 12/23/2022]
Abstract
Background In 2013, the English National Health Service launched the policy of 7-day services to improve care quality and outcomes for weekend emergency admissions. Aims To determine whether the quality of care of emergency medical admissions is worse at weekends, and whether this has changed during implementation of 7-day services. Methods Using data from 20 acute hospital Trusts in England, we performed randomly selected structured case record reviews of patients admitted to hospital as emergencies at weekends and on weekdays between financial years 2012–2013 and 2016–2017. Senior doctor (‘specialist’) involvement was determined from annual point prevalence surveys. The primary outcome was the rate of clinical errors. Secondary outcomes included error-related adverse event rates, global quality of care and four indicators of good practice. Results Seventy-nine clinical reviewers reviewed 4000 admissions, 800 in duplicate. Errors, adverse events and care quality were not significantly different between weekend and weekday admissions, but all improved significantly between epochs, particularly errors most likely influenced by doctors (clinical assessment, diagnosis, treatment, prescribing and communication): error rate OR 0.78; 95% CI 0.70 to 0.87; adverse event OR 0.48, 95% CI 0.33 to 0.69; care quality OR 0.78, 95% CI 0.70 to 0.87; all adjusted for age, sex and ethnicity. Postadmission in-hospital care processes improved between epochs and were better for weekend admissions (vital signs with National Early Warning Score and timely specialist review). Preadmission processes in the community were suboptimal at weekends and deteriorated between epochs (fewer family doctor referrals, more patients with chronic disease or palliative care designation). Conclusions and implications Hospital care quality of emergency medical admissions is not worse at weekends and has improved during implementation of the 7-day services policy. Causal pathways for the weekend effect may extend into the prehospital setting.
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Affiliation(s)
- Julian Bion
- Department of Intensive Care Medicine, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Cassie Aldridge
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alan J Girling
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jianxia Sun
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chris Beet
- Department of Intensive Care, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Amunpreet Boyal
- Department of Research & Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Rees
- Academy of Medical Royal Colleges, London, UK
| | - Chris Roseveare
- Department of Gastroenterology, Southern Health NHS Foundation Trust, Southampton, UK
| | - Mark Temple
- Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samuel Ian Watson
- Division of Health Sciences, Medical School, University of Warwick, Coventry, Warwickshire, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Medical School, University of Warwick, Coventry, Warwickshire, UK
| | - Mike Clancy
- Emergency Medicine, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Louise Rowan
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Joanne Lord
- University of Southampton, Southampton, Hampshire, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Timothy Hofer
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Richard Lilford
- Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK
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19
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Tolestam Heyman E, Engström M, Baigi A, Dahlén Holmqvist L, Lingman M. Likelihood of admission to hospital from the emergency department is not universally associated with hospital bed occupancy at the time of admission. Int J Health Plann Manage 2020; 36:353-363. [PMID: 33037715 PMCID: PMC8048858 DOI: 10.1002/hpm.3086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022] Open
Abstract
Background The decision to admit into the hospital from the emergency department (ED) is considered to be important and challenging. The aim was to assess whether previously published results suggesting an association between hospital bed occupancy and likelihood of hospital admission from the ED can be reproduced in a different study population. Methods A retrospective cohort study of attendances at two Swedish EDs in 2015 was performed. Admission to hospital was assessed in relation to hospital bed occupancy together with other clinically relevant variables. Hospital bed occupancy was categorized and univariate and multivariate logistic regression were performed. Results In total 89,503 patient attendances were included in the final analysis. Of those, 29.1% resulted in admission within 24 h. The mean hospital bed occupancy by the hour of the two hospitals was 87.1% (SD 7.6). In both the univariate and multivariate analysis, odds ratio for admission within 24 h from the ED did not decrease significantly with an increasing hospital bed occupancy. Conclusions A negative association between admission to hospital and occupancy level, as reported elsewhere, was not replicated. This suggests that the previously shown association might not be universal but may vary across sites due to setting specific circumstances.
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Affiliation(s)
- Ellen Tolestam Heyman
- Emergency Department, Region Halland, Varberg, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Engström
- Department of Healthcare, Region Halland Central Office, Region Halland, Sweden.,Department of Anaesthesia and Intensive Care, Medicine, Lund University, Lund, Sweden
| | - Amir Baigi
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Lina Dahlén Holmqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Emergency Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Lingman
- Halland Hospital Group, Region Halland, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Holiday and weekend effects on mortality for acute myocardial infarction in Shanxi, China: a cross-sectional study. Int J Public Health 2020; 65:847-857. [PMID: 32737560 DOI: 10.1007/s00038-020-01443-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine the effects of holiday and weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in China. METHODS Patients with AMI in 31 tertiary hospitals in Shanxi, China from 2014 to 2017 were included (N = 54,968). Multivariable logistic regression models were used to examine the effects of holiday and weekend admission on in-hospital mortality. RESULTS Compared to non-holiday and weekday admissions, holiday and weekend admissions, respectively, were associated with increases in risk-adjusted mortality rates. Chinese National Day was associated with an additional 10 deaths per 1000 admissions (95% confidence interval (CI): (0, 20))-a relative increase from baseline mortality of 64% (95% CI: (1%, 128%)). Sunday was associated with an additional 4 deaths per 1000 admissions (95% CI: (0, 7))-a relative increase from baseline mortality of 23% (95% CI: (3%, 45%)). We found no evidence of gender differences in holiday or weekend effects on mortality. CONCLUSIONS Holiday and weekend admissions were associated with in-hospital AMI mortality. The admissions on Chinese National Day and Sunday contributed to the observed "holiday effect" and "weekend effect," respectively.
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21
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Chiu CY, Oria D, Yangga P, Kang D. Quality assessment of weekend discharge: a systematic review and meta-analysis. Int J Qual Health Care 2020; 32:347-355. [PMID: 32453404 DOI: 10.1093/intqhc/mzaa060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the 'weekend effect.' However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. DATA SOURCES PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. STUDY SELECTION Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. DATA EXTRACTION Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. RESULTS OF DATA SYNTHESIS There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. CONCLUSION In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.
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Affiliation(s)
- Chia-Yu Chiu
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - David Oria
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - Peter Yangga
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - Dasol Kang
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
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22
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Wang C, Li X, Sun W, Li J, Wang Y, Bao X, Liu M, Zhang Q. Weekly variation in quality of care for acute ST-segment elevation myocardial infarction by day and time of admission: a retrospective observational study. BMJ Qual Saf 2020; 30:500-508. [PMID: 32669296 DOI: 10.1136/bmjqs-2019-010121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 06/06/2020] [Accepted: 06/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The admission time of patients with ST-segment elevation myocardial infarction (STEMI) may affect the quality of care they receive. This study aimed to explore the pattern and magnitude of variation in quality of care for patients with STEMI in both the process and outcome domains. METHODS We performed a retrospective study based on STEMI data from China. We estimated the adjusted ORs of six process indicators and one outcome indicator of STEMI care quality by fitting multilevel multivariable regression models across 42 4hour time periods per week. RESULTS The study cohort comprised 98 628 patients with STEMI. Care quality varied by time of arrival to the emergency department. We identified three main patterns of variation, which were consistent across days of the week. In the first pattern, which applied to electrocardiographic examination within 10 min of arrival and to aspirin or clopidogrel use within 10 min of arrival, quality was lowest for arrivals between 08:00 and 12:00, rose through the day and peaked for arrivals between 24:00 and 04:00. Percutaneous transluminal coronary intervention treatment within 90 min showed the same pattern but with maximal performance for those arriving 20:00-24:00. In the third pattern, applying to lipid function evaluation within 24 hours and beta blocker use within 24 hours, quality was best for arrivals between 04:00-08:00 and 16:00-19:00 and worst for arrivals between 24:00-04:00 and 12:00-16:00. CONCLUSIONS The quality of care for STEMI shows three patterns of diurnal variation. Detecting the times at which quality is relatively low may lead to quality improvement in healthcare. Quality improvement should focus on reducing the weekend effect and off-hour effect and the diurnal temporal variation.
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Affiliation(s)
- Chao Wang
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xi Li
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wantong Sun
- Department of Ophthalmology, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jingkun Li
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yupeng Wang
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaoqiang Bao
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Meina Liu
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qiuju Zhang
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
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23
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Affiliation(s)
- Gavin Rudge
- Research Fellow, Institute of Applied Health Research, College of Medical and Dental Sciences, The University of Birmingham, UK.,G. Rudge@bham. ac. uk
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24
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Tolvi M, Mattila K, Haukka J, Aaltonen LM, Lehtonen L. Weekend effect on mortality by medical specialty in six secondary hospitals in the Helsinki metropolitan area over a 14-year period. BMC Health Serv Res 2020; 20:323. [PMID: 32303202 PMCID: PMC7164185 DOI: 10.1186/s12913-020-05142-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The weekend effect is the phenomenon of a patient's day of admission affecting their risk for mortality. Our study reviews the situation at six secondary hospitals in the greater Helsinki area over a 14-year period by specialty, in order to examine the effect of centralization of services on the weekend effect. METHODS Of the 28,591,840 patient visits from the years 2000-2013 in our hospital district, we extracted in-patients treated only in secondary hospitals who died during their hospital stay or within 30 days of discharge. We categorized patients based on the type of each admission, namely elective versus emergency, and according to the specialty of their clinical service provider and main diagnosis. RESULTS A total of 456,676 in-patients (292,399 emergency in-patients) were included in the study, with 17,231 deaths in-hospital or within 30 days of discharge. A statistically significant weekend effect was observed for in-hospital and 30-day post-discharge mortality among emergency patients for 1 of 7 specialties. For elective patients, a statistically significant weekend effect was visible in in-hospital mortality for 4 of 8 specialties and in 30-day post-discharge mortality for 3 of 8 specialties. Surgery, internal medicine, and gynecology and obstetrics were most susceptible to this phenomenon. CONCLUSIONS A weekend effect was present for the majority of specialties for elective patients, indicating a need for guidelines for these admissions. More disease-specific research is necessary to find the diagnoses, which suffer most from the weekend effect and adjust staffing accordingly.
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Affiliation(s)
- Morag Tolvi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
| | - Kimmo Mattila
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Haukka
- Clinicum, Department of Public Health, University of Helsinki, Helsinki and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
| | - Lasse Lehtonen
- Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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25
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Bressman E, Rowland JC, Nguyen VT, Raucher BG. Severity of illness and the weekend mortality effect: a retrospective cohort study. BMC Health Serv Res 2020; 20:169. [PMID: 32131816 PMCID: PMC7057651 DOI: 10.1186/s12913-020-5029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/24/2020] [Indexed: 12/01/2022] Open
Abstract
Background Weekend admission to the hospital has been found to be associated with higher in-hospital mortality rates, but the cause for this phenomenon remains controversial. US based studies have been limited in their characterization of the weekend patient population, making it difficult to draw conclusions about the implications of this effect. Methods A retrospective cohort study, examining de-identified, patient level data from 2015 to 2017 at US academic medical centers submitting data to the Vizient database, comparing demographic and clinical risk profiles, as well as mortality, cost and length of stay, between weekend and weekday patient populations. Between-group differences in mortality were assessed using the chi-square test for categorical measures and Wilcoxon rank-sum test for continuous measures. Logistic regression models were used to test the multivariate association of weekend admission and other patient-level factors with death, LOS, etc. Results We analyzed 10,365,605 adult inpatient encounters. Within the weekend patient population, 30.6% of patients were categorized as having either a major or extreme risk of mortality on admission, as compared to 23.7% on weekdays (p < 0.001). We found a significantly increased unadjusted mortality rate associated with weekend admission (OR 1.46; 95% CI 1.45–1.47) which was substantially attenuated after adjusting for disease severity and other demographic covariates, though remained significant (OR 1.05; 95% CI 1.04–1.06). In the subgroup of non-elective admissions, the unadjusted OR for death was 1.14 (95% CI 1.13–1.15), and the adjusted OR was 1.04 (95% CI 1.03–1.05). Weekend admission was associated with a longer median LOS (4 vs 3 days in the weekday group; p < 0.01), but a lower median cost ($8224 vs $9999 dollars in the weekday group; p < 0.01). Conclusion The patient population admitted on weekends is proportionally higher risk than the population admitted on weekdays, and the observed weekend mortality effect is largely attributable to this risk imbalance.
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Affiliation(s)
- Eric Bressman
- Department of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY, 10128, USA.
| | - John C Rowland
- Department of Population Health Science and Policy at Mount Sinai, 1425 Madison Ave, New York, NY, 10128, USA
| | - Vinh-Tung Nguyen
- Department of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY, 10128, USA
| | - Beth G Raucher
- Department of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY, 10128, USA
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Endo H, Fushimi K, Otomo Y. The off-hour effect in severe trauma and the structure of care delivery among Japanese emergency and critical care centers: A retrospective cohort study. Surgery 2019; 167:653-660. [PMID: 31889544 DOI: 10.1016/j.surg.2019.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/07/2019] [Accepted: 10/14/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND The association between mortality and off-hour presentation to a medical center has been studied in relation to various diseases and settings, but little is known of what the association indicates. This study explored the association in severe trauma patients among Japanese emergency and critical care centers and their association with the structural factors of the medical center. METHODS We conducted a retrospective cohort study using a Japanese, nationwide administrative database and the annual emergency and critical care centers evaluation report. We included patients who were seen because of trauma, were at least 15 years old, were transferred to an emergency and critical care center by ambulance, were admitted to the intensive care unit, and were discharged between April 1, 2012 and March 31, 2017. Off-hour care was defined as initial care beginning at all times except 8 am to 6 pm on weekdays and 8 am to noon on Saturdays. We evaluated this topic using the structure-process-outcome model as proposed by Donabedian. A multilevel logistic regression analysis was performed. RESULTS The sample included 111,266 patients from 233 emergency and critical care centers. The adjusted mortality odds ratio for off-hour care was 0.90 (95% confidence interval: 0.85-0.96; P < .001). In the off-hour care cohort, the immediate availability of an operating room and off-hours work management including shift work introduction had adjusted mortality odds ratios of 0.85 (95% confidence interval: 0.74-0.98; P = .02) and 0.85 (95% confidence interval: 0.73-0.99; P = .04), respectively. CONCLUSION In Japan, severe trauma patients who received off-hour care at the emergency and critical care centers had a decreased in-hospital mortality. The immediate availability of an operating room and management of off-hours work were contributing structural factors. Process factors in off-hour care need to be considered in future research on this topic. This finding may have important applicability to other countries as well.
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Affiliation(s)
- Hideki Endo
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University, Japan
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Bion J. Weekend effect: complex metric for a complex pathway. BMJ Qual Saf 2019; 29:525-527. [PMID: 31874861 DOI: 10.1136/bmjqs-2019-010497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Julian Bion
- Intensive Care Medicine, University of Birmingham, Birmingham B15 2TH, UK
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28
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Jayawardana S, Salas-Vega S, Cornehl F, Krumholz HM, Mossialos E. The relationship between off-hours admissions for primary percutaneous coronary intervention, door-to-balloon time and mortality for patients with ST-elevation myocardial infarction in England: a registry-based prospective national cohort study. BMJ Qual Saf 2019; 29:541-549. [PMID: 31831635 PMCID: PMC7362773 DOI: 10.1136/bmjqs-2019-010067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 11/04/2022]
Abstract
Background The degree to which elevated mortality associated with weekend or night-time hospital admissions reflects poorer quality of care (‘off-hours effect’) is a contentious issue. We examined if off-hours admissions for primary percutaneous coronary intervention (PPCI) were associated with higher adjusted mortality and estimated the extent to which potential differences in door-to-balloon (DTB) times—a key indicator of care quality for ST elevation myocardial infarction (STEMI) patients—could explain this association. Methods Nationwide registry-based prospective observational study using Myocardial Ischemia National Audit Project data in England. We examined how off-hours admissions and DTB times were associated with our primary outcome measure, 30-day mortality, using hierarchical logistic regression models that adjusted for STEMI patient risk factors. In-hospital mortality was assessed as a secondary outcome. Results From 76 648 records of patients undergoing PPCI between January 2007 and December 2012, we included 42 677 admissions in our analysis. Fifty-six per cent of admissions for PPCI occurred during off-hours. PPCI admissions during off-hours were associated with a higher likelihood of adjusted 30-day mortality (OR 1.13; 95% CI 1.01 to 1.25). The median DTB time was longer for off-hours admissions (45 min; IQR 30–68) than regular hours (38 min; IQR 27–58; p<0.001). After adjusting for DTB time, the difference in adjusted 30-day mortality between regular and off-hours admissions for PPCI was attenuated and no longer statistically significant (OR 1.08; CI 0.97 to 1.20). Conclusion Higher adjusted mortality associated with off-hours admissions for PPCI could be partly explained by differences in DTB times. Further investigations to understand the off-hours effect should focus on conditions likely to be sensitive to the rapid availability of services, where timeliness of care is a significant determinant of outcomes.
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Affiliation(s)
- Sahan Jayawardana
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Sebastian Salas-Vega
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Felix Cornehl
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Harlan M Krumholz
- Center for Outcomes & Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK .,Centre for Health Policy, The Institute of Global Health Innovation, Imperial College London, London, UK
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Simpson R, Croft S, O'Keeffe C, Jacques R, Stone T, Ahmed N, Mason SM. Exploring the characteristics, acuity and management of adult ED patients at night-time. Emerg Med J 2019; 36:554-557. [PMID: 31362935 PMCID: PMC6818519 DOI: 10.1136/emermed-2018-208248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/14/2019] [Accepted: 07/12/2019] [Indexed: 11/04/2022]
Abstract
Objectives ED care is required for acutely unwell and injured patients 24 hours a day, 7 days a week. The aim of this study was to compare characteristics and activity of type 1 ED attendances according to whether their time of arrival was during the day (08:00–18:00) or at night (18:00–08:00). Methods Hospital Episode Statistics (HES) data from NHS Digital for all A&E and admitted patient care activity provided by all acute (not mental health or primary care) NHS hospital trusts in Yorkshire and Humber (1 April 2011 to 31 March 2014) for adult patients were analysed. Adjusted linear and logistic regression was used to model the data. Results Adjusted regression analysis results show that patients who attended ED at night waited an extra 18.76 (95% CI 18.62 to 18.89) min to be seen by a clinician. They also spent an additional 13.64 (95% CI 13.47 to 13.81) min total in ED. Patients who attended at night were OR 2.20 (95% CI 2.17 to 2.23) times more likely to leave without being seen. They were also OR 1.26 (95% CI 1.25 to 1.27) times more likely to re-attend the ED and were OR 1.20 (95% CI 1.19 to 1.21) times more likely to present with non-urgent conditions. Overnight patients were more likely to be admitted to hospital, OR 1.09 (95% CI 1.09 to 1.10) times, however, those admitted were more likely to have a short-stay admission. Conclusion There is an ‘overnight effect’ of patients attending EDs. Patients wait longer, leave without being seen, attend with non-urgent problems and are more likely to be admitted for a short stay. Further work is required to identify the potential underlying causes of these differences.
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Affiliation(s)
- Rebecca Simpson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Croft
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin O'Keeffe
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Stone
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nisar Ahmed
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Suzanne M Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Faust L, Feldman K, Chawla NV. Examining the weekend effect across ICU performance metrics. Crit Care 2019; 23:207. [PMID: 31171026 PMCID: PMC6554947 DOI: 10.1186/s13054-019-2479-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Known colloquially as the "weekend effect," the association between weekend admissions and increased mortality within hospital settings has become a highly contested topic over the last two decades. Drawing interest from practitioners and researchers alike, a sundry of works have emerged arguing for and against the presence of the effect across various patient cohorts. However, it has become evident that simply studying population characteristics is insufficient for understanding how the effect manifests. Rather, to truly understand the effect, investigations into its underlying factors must be considered. As such, the work presented in this manuscript serves to address this consideration by moving beyond identification of patient cohorts to examining the role of ICU performance. METHODS Employing a comprehensive, publicly available database of electronic medical records (EMR), we began by utilizing multiple logistic regression to identify and isolate a specific cohort in which the weekend effect was present. Next, we leveraged the highly detailed nature of the EMR to evaluate ICU performance using well-established ICU quality scorecards to assess differences in clinical factors among patients admitted to an ICU on the weekend versus weekday. RESULTS Our results demonstrate the weekend effect to be most prevalent among emergency surgery patients (OR 1.53; 95% CI 1.19, 1.96), specifically those diagnosed with circulatory diseases (P<.001). Differences between weekday and weekend admissions for this cohort included a variety of clinical factors such as ventilatory support and night-time discharges. CONCLUSIONS This work reinforces the importance of accounting for differences in clinical factors as well as patient cohorts in studies investigating the weekend effect.
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Affiliation(s)
- Louis Faust
- Department of Computer Science & Engineering, University of Notre Dame, Notre Dame, USA
| | - Keith Feldman
- Department of Computer Science & Engineering, University of Notre Dame, Notre Dame, USA
| | - Nitesh V Chawla
- Department of Computer Science & Engineering, University of Notre Dame, Notre Dame, USA.
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Sutton E, Bion J, Aldridge C, Boyal A, Willars J, Tarrant C. Quality and safety of in-hospital care for acute medical patients at weekends: a qualitative study. BMC Health Serv Res 2018; 18:1015. [PMID: 30594209 PMCID: PMC6310936 DOI: 10.1186/s12913-018-3833-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increased mortality risk associated with weekend admission to hospital (the 'weekend effect') has been reported across many health systems. More recently research has focused on causal mechanisms. Variations in the organisation and delivery of in-hospital care between weekends and weekdays have been identified, but this is not always to the detriment of weekend admissions, and the impact on mortality is uncertain. The insights of frontline staff and patients have been neglected. This article reports a qualitative study of patients and clinicians, to explore their views on quality and safety of care at weekends. METHODS We conducted focus groups and interviews with clinicians and patients with experience of acute medical care, recruited from three UK hospital Trusts. We analysed the data using a thematic analysis approach, aided by the use of NVivo, to explore quality and safety of care at weekends. RESULTS We held four focus groups and completed six in-depth interviews, with 19 clinicians and 12 patients. Four threats to quality and safety were identified as being more prominent at weekends, relating to i) the rescue and stabilisation of sick patients; ii) monitoring and responding to deterioration; iii) timely accurate management of the therapeutic pathway; iv) errors of omission and commission. CONCLUSIONS At weekends patients and staff are well aware of suboptimal staffing numbers, skill mix and access to resources at weekends, and identify that emergency admissions are prioritised over those already hospitalised. The consequences in terms of quality and safety and patient experience of care are undesirable. Our findings suggest the value of focusing on care processes and systems resilience over the weekends, and how these can be better supported, even in the limited resource environment that exists in many hospitals at weekends.
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Affiliation(s)
- Elizabeth Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Julian Bion
- University Hospitals Birmingham, Birmingham, UK
| | | | | | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
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