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Riaz Q, Mitha R, Shamim MS, Virani QUA, Belgaumi A, Khan MR, Roshan R, Zahid N, Haider A. Exploring the 'January effect' at a university hospital in Pakistan: a retrospective cohort study investigating the impact of trainee turnover on patient care quality outcomes. BMC MEDICAL EDUCATION 2023; 23:770. [PMID: 37845631 PMCID: PMC10577952 DOI: 10.1186/s12909-023-04708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE There are reports of a potential rise in a teaching hospital's morbidity and mortality rates during the trainee turnover period, i.e., with the induction of new residents and house staffs, and the changeover of clinical teams. The published literature displays mixed reports on this topic with lack of reproducible observations. The current study was conducted to explore existence of any such phenomenon (January effect) in Pakistan. METHODS This retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, Pakistan. Five-year (2013-2018) record of all the patients in all age groups related to these outcomes was retrieved and recorded in specifically designed questionnaire. Different outcome measures were used as indicators of patient care and change in these outcomes at the time of new induction was related to possible January effect. RESULTS During the five-year study period, more than 1100 new trainees were inducted into the post graduate medical education program (average of 237 per year) with more than 22,000 inpatient admissions (average of 45,469 per year). Some patterns were observed in frequencies of surgical site infections, medication errors, sentinel events, patient complaints, and adverse drug reactions. However, these were not consistently reproducible and could not be directly attributed to the trainee turnover. All other indicators did not show any pattern and were considered inconclusive. No effect of overlap was observed. CONCLUSIONS Inconsistency in the patient care quality indicators do not favor existence of January effect in our study. Further research is recommended to establish our results.
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Affiliation(s)
- Qamar Riaz
- Department for Educational Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Rida Mitha
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Shahzad Shamim
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Qurat-Ul-Ain Virani
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Rozina Roshan
- Department of Infection Prevention & Hospital Epidemiology (DIPHE), Aga Khan University Hospital (AKUH), Karachi, Pakistan
| | - Nida Zahid
- Aga Khan University Hospital, Karachi, Pakistan
| | - Adil Haider
- Aga Khan University Hospital, Karachi, Pakistan
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Casciato DJ, Thompson J, Law R, Faherty M, Barron I, Thomas R. The July Effect in Podiatric Medicine and Surgery Residency. J Foot Ankle Surg 2021; 60:1152-1157. [PMID: 34078561 DOI: 10.1053/j.jfas.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/26/2021] [Accepted: 04/22/2021] [Indexed: 02/03/2023]
Abstract
The period when medical students begin residency in teaching hospitals throughout the United States heralds a period known in the medical community as the "July Effect." Though several sentinel studies associated this timeframe with an increase in medical errors, residencies since demystified this phenomenon within their respective specialty. This study aims to evaluate the presence of the July Effect in a podiatric medicine and surgery residency program. A retrospective chart review was conducted, comparing patient demographics and surgical outcomes including length of stay, operative time and readmission rate between the first (July, August, September) and fourth (April, May June) quarters of the academic year from 2014-2019. A total of 206 patients met the inclusion criteria, where 99 received care in the first, resident-naïve, quarter and 107 received care in the fourth, resident-experienced, quarter. No difference in patient demographics including sex, body mass index, or comorbidity index was appreciated between both quarters (p<0.05). Those patients who underwent soft tissue and bone debridements, digital, forefoot, midfoot and rearfoot amputations experienced no statistically significant difference in length of stay, operative time, or readmission rate between both quarters (p<0.05). The results of this study did not support the presence of the July Effect in our foot and ankle surgery residency. Future studies can further explore this phenomenon by examining patients admitted following traumatic injury or elective procedures. Moreover, this study shows the curriculum employed at our program provides sufficient support, guidance, and resources to limit errors attributed to the July Effect.
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Affiliation(s)
- Dominick J Casciato
- Resident Physician, Medical Education Department, Grant Medical Center, Columbus, OH.
| | - John Thompson
- Resident Physician, Medical Education Department, Grant Medical Center, Columbus, OH
| | - Rona Law
- Fellow, Mon Valley Foot and Ankle Fellowship, Belle Vernon, PA
| | - Mallory Faherty
- OhioHealth Research Institute, Riverside Methodist Hospital, Columbus, OH
| | - Ian Barron
- Teaching Faculty, Medical Education Department, Grant Medical Center, Columbus, OH
| | - Randall Thomas
- Teaching Faculty, Medical Education Department, Grant Medical Center, Columbus, OH
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Hospitalization and Post-hospitalization Outcomes Among Teaching Internal Medicine, Employed Hospitalist, and Locum Tenens Hospitalist Services in a Tertiary Center: a Prospective Cohort Study. J Gen Intern Med 2021; 36:3040-3051. [PMID: 33495887 PMCID: PMC7832420 DOI: 10.1007/s11606-020-06578-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/29/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are no prospective studies comparing hospitalization and post-hospitalization outcomes between teaching internal medicine services and non-teaching hospitalists, and no prospective studies comparing these outcomes between locum and employed hospitalists. OBJECTIVE To compare the length of stay, hospital costs readmission rate, and mortality rate in patients treated by teaching internal medicine services vs. hospitalists and among patients treated by locum vs. employed hospitalists. DESIGN Prospective cohort study. Propensity score was used to obtain weighted estimates. SETTING Referral center. PATIENTS All patients 18 years and older admitted to internal medicine services. INTERVENTION Treatment by teaching internal medicine services vs. hospitalists. Treatment by locum hospitalists vs. employed hospitalists. MAIN MEASURES Primary outcome was adjusted length of stay and secondary outcomes included hospital cost, inpatient mortality, 30-day all-cause readmission, and 30-day mortality. KEY RESULTS A total of 1273 patients were admitted in the study period. The mean patient age was 61 ± 19 years, and the sample was 52% females. Teaching internal medicine physicians admitted 526 patients and non-teaching hospitalists admitted 747 patients. Being seen exclusively by teaching internal medicine physicians comports with a shorter adjusted hospital stay by 0.6 days (95% CI - 1.07 to - 0.22, P = .003) compared to non-teaching hospitalists. Adjusted length of stay was 1 day shorter in patients seen exclusively by locums compared to patients seen exclusively by employed services (95% CI - 1.6 to - 0.43, P < .001) with an adjusted average hospital cost saving of 1339 dollars (95% CI - 2037 to - 642, P < .001). There was no statistically significant difference in other outcomes. CONCLUSIONS Teaching internal medicine services care was associated with a shorter stay but not with increased costs, readmission, or mortality compared to non-teaching services. In contrary to the "expected," patients treated by locums had shorter stays and decreased hospital costs but no increase in readmissions or mortality.
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Kirshenbaum EJ, Blackwell RH, Li B, Eguia E, Janjua HM, Cobb AN, Baldea K, Kuo PC, Gorbonos A. The July Effect in Urological Surgery—Myth or Reality? UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Eric J. Kirshenbaum
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
| | - Robert H. Blackwell
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
| | - Belinda Li
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Emanuel Eguia
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Haroon M. Janjua
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Adrienne N. Cobb
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Kristin Baldea
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Paul C. Kuo
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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Moore NH, Fondahn ED, Baty JD, Blanchard MS. Impact of a hospital bounceback policy to reduce readmissions. Healthcare (Basel) 2018; 6:41-45. [DOI: 10.1016/j.hjdsi.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022] Open
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Blough JT, Jordan SW, De Oliveira GS, Vu MM, Kim JYS. Demystifying the "July Effect" in Plastic Surgery: A Multi-Institutional Study. Aesthet Surg J 2018; 38:212-224. [PMID: 29040397 DOI: 10.1093/asj/sjx099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The "July Effect" refers to a theoretical increase in complications that may occur with the influx of inexperienced interns and residents at the beginning of each academic year in July. OBJECTIVES We endeavored to determine if a July Effect occurs in plastic surgery. METHODS Plastic surgery procedures were isolated from the National Surgical Quality Improvement Program registry. Cases involving residents were grouped as either having occurred within the first academic quarter (AQ1) or remaining year (AQ2-4). Groups were propensity matched using patient/operative factors and procedure type to account for baseline differences. Univariate and multivariate regression analyses assessed differences in overall complications, surgical and medical complications, individual complications, length of hospital stay, and operative time. A comparison group comprised of procedures without resident involvement was also analyzed. RESULTS There were 5967 cases with resident involvement, 5156 of which successfully matched. Both univariate and multivariate regression analyses revealed no significant differences between AQ1 and AQ2-4 in terms of overall, surgical, medical and individual complications, or length of hospital stay. There was a statistically significant, albeit not clinically significant, increase in operative time by 10 minutes per procedure during AQ1 in comparison to AQ2-4 (P = 0.001). For procedures lacking resident participation, there were no differences between AQ1 and AQ2-4 in terms of these outcomes. CONCLUSIONS A July Effect was not observed for plastic surgery procedures in our study, conceivably due to enhanced resident oversight and infrastructural safeguards. Patients electing to undergo plastic surgery early in the academic year can be reassured of their safety during this period.
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Affiliation(s)
- Jordan T Blough
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sumanas W Jordan
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Michael M Vu
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John YS Kim
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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Englander R, Flynn T, Call S, Carraccio C, Cleary L, Fulton TB, Garrity MJ, Lieberman SA, Lindeman B, Lypson ML, Minter RM, Rosenfield J, Thomas J, Wilson MC, Aschenbrener CA. Toward Defining the Foundation of the MD Degree: Core Entrustable Professional Activities for Entering Residency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1352-1358. [PMID: 27097053 DOI: 10.1097/acm.0000000000001204] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Currently, no standard defines the clinical skills that medical students must demonstrate upon graduation. The Liaison Committee on Medical Education bases its standards on required subject matter and student experiences rather than on observable educational outcomes. The absence of such established outcomes for MD graduates contributes to the gap between program directors' expectations and new residents' performance.In response, in 2013, the Association of American Medical Colleges convened a panel of experts from undergraduate and graduate medical education to define the professional activities that every resident should be able to do without direct supervision on day one of residency, regardless of specialty. Using a conceptual framework of entrustable professional activities (EPAs), this Drafting Panel reviewed the literature and sought input from the health professions education community. The result of this process was the publication of 13 core EPAs for entering residency in 2014. Each EPA includes a description, a list of key functions, links to critical competencies and milestones, and narrative descriptions of expected behaviors and clinical vignettes for both novice learners and learners ready for entrustment.The medical education community has already begun to develop the curricula, assessment tools, faculty development resources, and pathways to entrustment for each of the 13 EPAs. Adoption of these core EPAs could significantly narrow the gap between program directors' expectations and new residents' performance, enhancing patient safety and increasing residents', educators', and patients' confidence in the care these learners provide in the first months of their residency training.
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Affiliation(s)
- Robert Englander
- R. Englander was senior director of competency-based learning and assessment, Association of American Medical Colleges, Washington, DC, at the time this work was done. He is now associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota.T. Flynn is senior associate dean for clinical affairs, University of Florida College of Medicine, Gainesville, Florida.S. Call is program director for internal medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.C. Carraccio is vice president for competency-based assessment programs, American Board of Pediatrics, Chapel Hill, North Carolina.L. Cleary is vice president for academic affairs, State University of New York Upstate Medical University, Syracuse, New York.T.B. Fulton is professor of biochemistry and biophysics and competency director for medical knowledge, University of California, San Francisco, School of Medicine, San Francisco, California.M.J. Garrity is associate professor of medicine and physiology and associate dean, University of Colorado Anschutz Medical Campus, Aurora, Colorado.S.A. Lieberman is senior dean for administration, University of Texas Medical Branch School of Medicine, Galveston, Texas.B. Lindeman is chief resident, Department of General Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.M.L. Lypson is professor of internal medicine and learning health sciences, University of Michigan Medical School, and associate chief of staff for education, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.R.M. Minter was associate professor of surgery and learning health sciences, associate chair for education, Department of Surgery, and associate program director in general surgery, University of Michigan Medical School, Ann Arbor, Michigan, at the time this work was done. She is now professor and Alvin Baldwin Jr. Chair, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.J. Rosenfield is vice dean of the MD program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.J. Thomas is a resident in emergency medicine, Mayo Clinic, Rochester, Minnesota.M.C. Wilson is clinical professor of internal medicine and associate dean for graduate medical education, University of Iowa Carver College of Medicine, and designated institutional official, University of Iowa Hospitals and Clinics, Iowa City, Iowa.C.A. Aschenbrener was chief medical education officer, Association of American Medical Colleges, Washington, DC, at the time this work was done
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Chousterman BG, Pirracchio R, Guidet B, Aegerter P, Mentec H. Impact of Resident Rotations on Critically Ill Patient Outcomes: Results of a French Multicenter Observational Study. PLoS One 2016; 11:e0162552. [PMID: 27627449 PMCID: PMC5023104 DOI: 10.1371/journal.pone.0162552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/24/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The impact of resident rotation on patient outcomes in the intensive care unit (ICU) has been poorly studied. The aim of this study was to address this question using a large ICU database. METHODS We retrospectively analyzed the French CUB-REA database. French residents rotate every six months. Two periods were compared: the first (POST) and fifth (PRE) months of the rotation. The primary endpoint was ICU mortality. The secondary endpoints were the length of ICU stay (LOS), the number of organ supports, and the duration of mechanical ventilation (DMV). The impact of resident rotation was explored using multivariate regression, classification tree and random forest models. RESULTS 262,772 patients were included between 1996 and 2010 in the database. The patient characteristics were similar between the PRE (n = 44,431) and POST (n = 49,979) periods. Multivariate analysis did not reveal any impact of resident rotation on ICU mortality (OR = 1.01, 95% CI = 0.94; 1.07, p = 0.91). Based on the classification trees, the SAPS II and the number of organ failures were the strongest predictors of ICU mortality. In the less severe patients (SAPS II<24), the POST period was associated with increased mortality (OR = 1.65, 95%CI = 1.17-2.33, p = 0.004). After adjustment, no significant association was observed between the rotation period and the LOS, the number of organ supports, or the DMV. CONCLUSION Resident rotation exerts no impact on overall ICU mortality at French teaching hospitals but might affect the prognosis of less severe ICU patients. Surveillance should be reinforced when treating those patients.
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Affiliation(s)
| | - Romain Pirracchio
- Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, AP-HP, Paris, France
- Centre de Recherche en Epidémiologie, Equipe ECSTRA, INSERM 1153, PRES Sorbonne Paris Cité, Paris, France
- Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Bertrand Guidet
- Service de Réanimation Médicale, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Philippe Aegerter
- Département d'Information Hospitalière et Santé Publique—Unité de Recherche Clinique, Hôpital Ambroise Paré, AP-HP, Boulogne, France
| | - Hervé Mentec
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - CUB-REA network
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
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Watkins AA, Bliss LA, Cameron DB, Eskander MF, Tseng JF, Kent TS. Deconstructing the "July Effect" in Operative Outcomes: A National Study. J Gastrointest Surg 2016; 20:1012-9. [PMID: 26932502 DOI: 10.1007/s11605-016-3120-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/22/2016] [Indexed: 01/31/2023]
Abstract
This study analyzes the relationship between hospital teaching status, failure to rescue, and time of year in select gastrointestinal operations. Procedure codes for laparoscopic cholecystectomy, colectomy, and pancreatectomy were queried from the Nationwide Inpatient Sample (2004-2011). Failure to rescue was defined as inpatient mortality when ≥1 complication. A total of 2,777,267 laparoscopic cholecystectomies, 2,519,903 colectomies, and 129,619 pancreatectomies were performed. Teaching hospitals had increased overall rates of failure to rescue compared to non-teaching hospitals, 10.0 vs. 9.5 % (p = 0.0187), particularly between May and August. There was greater inter-month variability in non-teaching hospitals amongst individual operations. On multivariable analysis, July was not predictive of increased odds of failure to rescue. Teaching status, hospital characteristics, and patient demographics were associated with increased odds of failure to rescue. Although teaching hospitals have a higher overall failure to rescue rate amongst the selected gastrointestinal operations, odds of failure to rescue are not increased in the month of July. Non-teaching hospitals tend to exhibit more monthly variation in failure to rescue rates, and hospital/patient demographics are predictive of failure to rescue. Further investigation targeted at identifying drivers of temporal variation is warranted to optimize patient outcomes.
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Affiliation(s)
- Ammara A Watkins
- Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA
| | - Lindsay A Bliss
- Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA
| | | | | | - Jennifer F Tseng
- Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA
| | - Tara S Kent
- Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA.
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Auger KA, Davis MM. Pediatric weekend admission and increased unplanned readmission rates. J Hosp Med 2015; 10:743-5. [PMID: 26381150 DOI: 10.1002/jhm.2426] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/26/2015] [Accepted: 06/27/2015] [Indexed: 11/09/2022]
Abstract
Outcomes for patients hospitalized on weekends are often worse for adults-the so-called "weekend effect." Less is known about the weekend effect for children. We examined 55,383 hospitalizations at a tertiary care children's hospital. We used logistic regression to examine the associations of weekend admission and weekend discharge with unplanned 30-day readmission. We adjusted analyses for patient and hospitalization characteristics including number of complex chronic conditions, technology dependency, and length of stay. The 30-day unplanned readmission rate was 10.3%. Children admitted on the weekend had significantly higher odds of unplanned readmission compared to children admitted on weekdays (adjusted odds ratio = 1.09 [95% confidence interval: 1.004-1.18]). In contrast, being discharged on the weekend was not associated with readmission. In conclusion, children admitted on the weekend have higher rates of 30-day unplanned readmission than children admitted during the week, suggesting care differences on the weekend related to initial clinical management rather than discharge planning.
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Affiliation(s)
- Katherine A Auger
- General Pediatrics, Division of Hospital Medicine and James M. Anderson Center for Healthcare Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew M Davis
- Departments of Pediatrics, Internal Medicine, and Public Policy, Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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