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Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital
BACKGROUND: Emergency hospital admission on weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day—not time—of admission. We used an enhanced longitudinal data set to estimate the ‘weekend effect’ over time and the e...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965349/ https://www.ncbi.nlm.nih.gov/pubmed/28971886 http://dx.doi.org/10.1136/bmjqs-2017-006784 |
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author | Han, Lu Sutton, Matt Clough, Stuart Warner, Richard Doran, Tim |
author_facet | Han, Lu Sutton, Matt Clough, Stuart Warner, Richard Doran, Tim |
author_sort | Han, Lu |
collection | PubMed |
description | BACKGROUND: Emergency hospital admission on weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day—not time—of admission. We used an enhanced longitudinal data set to estimate the ‘weekend effect’ over time and the effect of night-time admission on all-cause mortality rates. METHODS: We examined 246 350 emergency spells from a large teaching hospital in England between April 2004 and March 2014. Outcomes included 7-day, 30-day and in-hospital mortality rates. We conducted probit regressions to estimate the impact on the absolute difference in the risk of mortality of two key predictors: (1) admission on weekends (19:00 Friday to 06:59 Monday); and (2) night-time admission (19:00 to 06:59). Logistic regressions were used to estimate ORs for relative mortality risk differences. RESULTS: Crude 30-day mortality rate decreased from 6.6% in 2004/2005 to 5.2% in 2013/2014. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission on weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.17, 95% CI 1.10 to 1.25), 7-day mortality by 0.5 percentage points (adjusted OR: 1.23, 95% CI 1.12 to 1.34) and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.14, 95% CI 1.08 to 1.21) compared with admission on weekday daytimes. Weekend night-time admission was associated with increased mortality risk in 9 out of 10 years, but this was only statistically significant (p<0.05) in 5 out of 10 years. CONCLUSIONS: There is an increased risk of mortality for patients admitted as emergencies both on weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night on weekends. This increased risk appears to be consistent over time, but the effects are small and are not statistically significant in individual hospitals in every year. |
format | Online Article Text |
id | pubmed-5965349 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-59653492018-05-31 Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital Han, Lu Sutton, Matt Clough, Stuart Warner, Richard Doran, Tim BMJ Qual Saf Original Research BACKGROUND: Emergency hospital admission on weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day—not time—of admission. We used an enhanced longitudinal data set to estimate the ‘weekend effect’ over time and the effect of night-time admission on all-cause mortality rates. METHODS: We examined 246 350 emergency spells from a large teaching hospital in England between April 2004 and March 2014. Outcomes included 7-day, 30-day and in-hospital mortality rates. We conducted probit regressions to estimate the impact on the absolute difference in the risk of mortality of two key predictors: (1) admission on weekends (19:00 Friday to 06:59 Monday); and (2) night-time admission (19:00 to 06:59). Logistic regressions were used to estimate ORs for relative mortality risk differences. RESULTS: Crude 30-day mortality rate decreased from 6.6% in 2004/2005 to 5.2% in 2013/2014. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission on weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.17, 95% CI 1.10 to 1.25), 7-day mortality by 0.5 percentage points (adjusted OR: 1.23, 95% CI 1.12 to 1.34) and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.14, 95% CI 1.08 to 1.21) compared with admission on weekday daytimes. Weekend night-time admission was associated with increased mortality risk in 9 out of 10 years, but this was only statistically significant (p<0.05) in 5 out of 10 years. CONCLUSIONS: There is an increased risk of mortality for patients admitted as emergencies both on weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night on weekends. This increased risk appears to be consistent over time, but the effects are small and are not statistically significant in individual hospitals in every year. BMJ Publishing Group 2018-06 2017-09-29 /pmc/articles/PMC5965349/ /pubmed/28971886 http://dx.doi.org/10.1136/bmjqs-2017-006784 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Original Research Han, Lu Sutton, Matt Clough, Stuart Warner, Richard Doran, Tim Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital |
title | Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital |
title_full | Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital |
title_fullStr | Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital |
title_full_unstemmed | Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital |
title_short | Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital |
title_sort | impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965349/ https://www.ncbi.nlm.nih.gov/pubmed/28971886 http://dx.doi.org/10.1136/bmjqs-2017-006784 |
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