Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study

Outcomes of Common General Surgery Patients Discharged Over Weekends at a Tertiary Care Hospital in Taif, Saudi Arabia

Introduction: The admission of patients on weekends in multiple health centers has been associated with poorer outcomes relative to care provided during regular weekday hours. This study aimed to assess and compare the health outcomes of patients discharged on weekends and weekdays after undergoing surgery in a tertiary hospital in Taif, Saudi Arabia.

Materials and methods: The data of patients were collected from hospital records in a retrospective manner, and the outcomes were assessed after discharge. Patients discharged on Friday and Saturday were considered weekend discharges, and those discharged on other days were considered weekday discharges. Data related to readmission and emergency department (ED) visits included the primary diagnosis, number of days post-primary discharge, length of stay, chief complaint, and the number of ED visits. A logistic regression model was done to assess the predictive factor for 30-readmission after surgery. 

Results: The frequency of discharge over the weekend was 9.1%. About 6.5% and 7.3% were found to have 30-day readmission and 30-day ED visits, respectively. A statistically significant association was not observed between weekend discharge and the development of postoperative complications (p>0.05). A multinomial logistic regression showed that patients who had emergency admission, postoperative complications, and the presence of cancer were found to be independently associated with 30-day readmission after discharge (P<0.05).

Conclusion: Proactive strategies to reduce costly readmissions after surgery can be designed once the high-risk patient subset is identified.

Variation in clinical care associated with weekend admission and discharge in psychiatric in-patient units: retrospective case-note review

BACKGROUND

Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.

AIMS

To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the 'working week'.

METHOD

Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.

RESULTS

In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39-0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46-0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30-0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50-0.97).

CONCLUSIONS

There is no evidence of a 'weekend effect' for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.