After-hours emergency department care: Does time or day of arrival affect survival?
health services research
healthcare disparity
night care
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
03
06
2020
received:
17
12
2019
accepted:
09
07
2020
pubmed:
11
9
2020
medline:
2
10
2021
entrez:
10
9
2020
Statut:
ppublish
Résumé
To determine whether after-hours presentation to EDs is associated with differences in 7-day and 30-day mortality. The influence of patient case-mix and workforce staffing differences are also explored. We conducted a retrospective observational study of 3.7 million ED episodes across 30 public hospitals in Queensland, Australia during May 2013-September 2015 using routinely collected hospital data linked to hospital staffing data and the death registry. Episodes were categorised as within/after-hours using time of presentation. Staffing was derived from payroll records and explored by defining 11 staffing ratios. Weekend presentation was slightly more associated (7-day mortality odds ratio 1.05, 95% confidence interval [CI] 1.01-1.10) or no more associated (30-day mortality odds ratio 1.01, 95% CI 0.98-1.03) with death than weekday presentation. When weeknights are included in the 'after-hours' period, odds ratios are smaller, so that after-hours presentation is no more associated (7-day mortality odds ratio 1.03, 95% CI 0.99-1.08) or less associated (30-day mortality odds ratio 0.95, 95% CI 0.93-0.97) with death. No significant after-hours patient case-mix differences were observed between weekday and weekend presentations for 7-day mortality. In other combinations of outcome and after-hours definition, some differences (especially measures relating to severity of presenting condition) were found. Staffing ratios were not strongly associated with any within/after-hours differences in ED mortality. After-hours presentation on the weekend to an ED is associated with higher 7-day mortality even after controlling for case-mix.
Identifiants
pubmed: 32909351
doi: 10.1111/1742-6723.13602
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
232-241Informations de copyright
© 2020 Australasian College for Emergency Medicine.
Références
Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N. Engl. J. Med. 2001; 345: 663-8.
Freemantle N, Richardson M, Wood J et al. Weekend hospitalization and additional risk of death: an analysis of inpatient data. J. R. Soc. Med. 2012; 105: 74-84.
Freemantle N, Ray D, McNulty D et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ 2015; 4596: h4596.
de Cordova PB, Phibbs CS, Bartel AP, Stone PW. Twenty-four/seven: a mixed-method systematic review of the off-shift literature. J. Adv. Nurs. 2012; 68: 1454-68.
Cavallazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of admission to the ICU and mortality: a systematic review and meta-analysis. Chest J. 2010; 138: 68-75.
Hinds AM, Ahmad D, Lopez KT, Matteson-Kome ML, Bechtold ML. Weekday vs weekend endoscopy: is there a true difference in patient outcomes? A meta-analysis. World J. Meta-Anal. 2014; 2: 29-35.
Mikulich O, Callaly E, Bennett K et al. The increased mortality associated with a weekend emergency admission is due to increased illness severity and altered case-mix. Acute Med. 2010; 10: 182-7.
Schmulewitz L, Proudfoot A, Bell D. The impact of weekends on outcome for emergency patients. Clin. Med. 2005; 5: 621-5.
Clarke MS, Wills R, Bowman RV et al. Exploratory study of the ‘weekend effect’ for acute medical admissions to public hospitals in Queensland, Australia. Intern. Med. J. 2010; 40: 777-83.
Maggs F, Mallet M. Mortality in out-of-hours emergency medical admissions - more than just a weekend effect. J. Roy. Coll. Phys. Edinb. 2010; 40: 115-8.
Smith S, Allan A, Greenlaw N et al. Emergency medical admissions, deaths at weekends and the public holiday effect. Cohort study. Emerg. Med. J. 2014; 31: 30-4.
Australasian College for Emergency Medicine. Statement on the Delineation of Emergency Departments. 2012. [Cited Apr 2020.] Available from URL: https://acem.org.au/getmedia/aa6c120d-bd9f-4850-a257-2b9a8f3860b3/S12_Statement_on_the_Delineation_EDs_Nov-12_v05-(1).aspx
Walker AS, Mason A, Quan TP et al. Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records. Lancet 2017; 6736: 1-11.
Bell A, McDonald F, Hobson T. The ethical imperative to move to a seven-day care model. J. Bioeth. Inq. 2016; 13: 251-60.
Australian Institute of Health and Welfare. Australian Hospital Peer Groups. Health Services Series No. 66. Cat. No. HSE 170. 2015. [Cited Apr 2020.] Available from URL: https://www.aihw.gov.au/reports/hospitals/australian-hospital-peer-groups/formats
Ben-Tovim D, Woodman R, Harrison JE, Pointer S, Hakendorf P, Henley G. Measuring and Reporting Mortality in Hospital Patients. Cat. No. HSE 69. 2009. [Cited Jun 2020.] Available from URL: https://www.aihw.gov.au/reports/hospitals/measuring-and-reporting-mortality-in-hospital-pati/contents/table-of-contents
Garnick DW, DeLong ER, Luft HS. Measuring hospital mortality rates: are 30-day data enough? Health Serv. Res. 1995; 29: 679-95.
Ozdemir BA, Sinha S, Karthikesalingam A et al. Mortality of emergency general surgical patients and associations with hospital structures and processes. Br. J. Anaesth. 2016; 116: 54-62.
Aldridge C, Bion J, Boyal A et al. Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. Lancet 2016; 388: 178-86.
Good NM, Khanna S, Boyle J. In-hospital mortality and the ‘weekend effect’: can we find the underlying causes? 3rd IEEE EMBS Int. Conf. Biomed. Health Inform. 2016; 2016: 336-9.
Anselmi L, Meacock R, Kristensen SR, Doran T, Sutton M. Arrival by ambulance explains variation in mortality by time of admission: retrospective study of admissions to hospital following emergency department attendance in England. BMJ Qual. Saf. 2017; 26: 613-21.
Meacock R, Anselmi L, Kristensen SR, Doran T, Sutton M. Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission. J. Health Serv. Res. Policy 2017; 22: 12-9.
Harrell Jr, FE. rms: Regression Modeling Strategies: 2017. https://CRAN.R-project.org/package=rms.
Australian Institute of Health and Welfare. Australian Hospital Statistics 2013-14: Emergency Department Care. Health Services Series No. 58. Cat. No. HSE 153. 2014. [Cited Nov 2019.] Available from URL: https://www.aihw.gov.au/reports/hospitals/ahs-2013-14-emergency-department-care/formats
Aylin P, Yunus A, Bottle A, Majeed A, Bell D. Weekend mortality for emergency admissions. A large, multicentre study. Qual. Saf. Health Care 2010; 19: 213-7.
Sharp AL, Choi H, Hayward RA. Don't get sick on the weekend: an evaluation of the weekend effect on mortality for patients visiting US EDs. Am. J. Emerg. Med. 2013; 31: 835-7.
Concha OP, Gallego B, Hillman K, Delaney GP, Coiera E. Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? a population-based study. BMJ Qual. Saf. 2014; 23: 215-22.
Xie Y, Khanna S, Good N et al. Weekly hospital workforce data: a data visualisation exercise. Stud. Health Technol. Inform. 2017; 239: 153-9.
Neuraz A, Guérin C, Payet C et al. Patient mortality is associated with staff resources and workload in the ICU: a multicenter observational study. Crit. Care Med. 2015; 43: 1587-94.
Ricciardi R, Nelson J, Roberts PL, Marcello PW, Read TE, Schoetz DJ. Is the presence of medical trainees associated with increased mortality with weekend admission? BMC Med. Educ. 2014; 14: 4.