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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...

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Autores principales: Han, Lu, Sutton, Matt, Clough, Stuart, Warner, Richard, Doran, Tim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
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.
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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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