Out-of-hours and weekend admissions to Danish medical departments: admission rates and 30-day mortality for 20 common medical conditions

OBJECTIVES: Knowledge on timing of admissions and mortality for acute medical patients is limited. The aim of the study was to examine hospital admission rates and mortality rates for patients with common medical conditions according to time of admission. DESIGN: Nationwide population-based cohort study. SETTING: Population of Denmark. PARTICIPANTS: Using the Danish National Registry of Patients covering all Danish hospitals, we identified all adults with the first acute admission to a medical department in Denmark during 2010. PRIMARY AND SECONDARY OUTCOME MEASURES: Hourly admission rates and age-standardised and sex-standardised 30-day mortality rates comparing weekday office hours, weekday out of hours, weekend daytime hours and weekend night-time hours. RESULTS: In total, 174 192 acute medical patients were included in the study. The admission rates (patients per hour) were 38.7 (95% CI 38.4 to 38.9) during weekday office hours, 13.3 (95% CI 13.2 to 13.5) during weekday out of hours, 19.8 (95% CI 19.6 to 20.1) during weekend daytime hours and 7.9 (95% CI 7.8 to 8.0) during weekend night-time hours. Admission rates varied between medical conditions. The proportion of patients admitted to an intensive care unit (ICU) increased outside of office hours. The age-standardised and sex-standardised 30-day mortality rate was 5.1% (95% CI 5.0% to 5.3%) after admission during weekday office hours, 5.7% (95% CI 5.5% to 6.0%) after admission during weekday out of hours, 6.4% (95% CI 6.1% to 6.7%) after admission during weekend daytime hours and 6.3% (95% CI 5.9% to 6.8%) after admission during weekend night-time hours. For the majority of the medical conditions examined, weekend admission was associated with highest mortality. CONCLUSIONS: While admission rates decreased from office hours to weekend hours there was an observed increase in mortality. This may reflect differences in severity of illness as the proportion admitted to an ICU increased during the weekend.