Cancer care

No weekend effect found in study of Australian hospitals

Hospital staffers have no need to feel guilty about the level of care they provide on the weekend with evidence from New South Wales that weekend admissions are not associated with increased mortality.

The retrospective analysis comprised 148,722 patients admitted to NSW hospitals between July 2009 and June 2012 with COPD, pneumonia, ischaemic or haemorrhagic stroke, acute myocardial infarction or congestive heart failure.

Most admissions (85.6%) were linked to an ED presentation and the most frequent day of presentation was a Monday. There were 17,721 deaths recorded within 30 days of the admissions.

The study predicted that if a weekend or out-of-hours effect on mortality existed, the strongest effect would be evident in the most urgent conditions such as stroke and AMI compared to less urgent conditions such as COPD.

However the study found no association between day of the week of admission and mortality for five of the six conditions and no true weekend effect for COPD.

“Significant variation in mortality by day of week for COPD was not consistent with a weekend effect (with Thursday, Friday and Saturday being associated with higher mortality compared with Monday),” the study said.

“This is consistent with studies which have shown more complex patterns of temporal variation in that there are some days/weeks that are different but not specifically ‘the weekend’.”

Consistent with other studies, they also found higher mortality among patients with stroke who presented to hospital overnight.

However the fact the night effect was only seen in stroke suggested it was not related to system-wide deficiencies.

“This finding may reflect factors specific to stroke such as that strokes occurring at night may take longer to recognise due to reduced activity, and may result in delayed seeking of treatment and therefore higher mortality.”

The researchers noted that their analysis was limited by a lack of contextual information such as the availability of clinical or laboratory staff on weekends versus weekdays or nights versus days.

“Further research is needed to determine whether lower staffing levels and resource access on weekends and out-of-hours may exhibit effects on other outcomes or processes, such as adverse events, delays in test results or care, or other quality indicators.”

“It would be interesting to consider the results on the level of individual hospitals, as hospital variation in quality of care on weekends may be masked in this type of global analysis.”

The findings are published in BMJ Open.

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