Is there a 'weekend effect' on mortality among hospitalised patients in an internal medicine ward? A retrospective study.
hospitalisation
internal ward
mortality
understaffing
weekend effect
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
15
11
2021
accepted:
11
02
2022
medline:
24
7
2023
pubmed:
22
2
2022
entrez:
21
2
2022
Statut:
ppublish
Résumé
Previous studies demonstrated a 'weekend effect' and a 'night effect' of increased mortality among patients admitted during weekends or night shifts, presumably due to understaffing. To examine whether death during hospitalisation follows a similar effect regardless of admission time. A retrospective cohort study among deceased patients hospitalised in the internal medicine wing of a tertiary medical centre in Israel, between 2019 and 2020. Demographic and medical data were retrieved from electronic medical charts. Causes of death were specifically categorised. We applied statistical models to test for differences in mortality using incidence rate ratio (IRR) according to the day, time and cause of death. One thousand, two hundred and seventy-eight deceased patients were included. All-cause mortality was similar between weekends and weekdays. When sepsis was the cause of death, higher IRR were demonstrated on Fridays in comparison with weekdays (IRR 1.4; 95% confidence interval (CI) 1.1-1.9; P < 0.05). Other causes of death were not consistent with a 'weekend effect'. Mortality during night shifts was higher in comparison with the afternoon (IRR 1.5; 95% CI 1.3-4.7) and similar to the morning (IRR 1; 95% CI 0.9-1.2). Our study did not find a pattern of 'weekend effect' or 'night effect' on all-cause mortality among hospitalised patients in internal medicine wards. Our findings suggest that perhaps specifically death from sepsis, and not all-cause mortality, can be used as a surrogate for the measurement of understaffing or quality of care in the internal ward.
Sections du résumé
BACKGROUND
Previous studies demonstrated a 'weekend effect' and a 'night effect' of increased mortality among patients admitted during weekends or night shifts, presumably due to understaffing.
AIMS
To examine whether death during hospitalisation follows a similar effect regardless of admission time.
METHODS
A retrospective cohort study among deceased patients hospitalised in the internal medicine wing of a tertiary medical centre in Israel, between 2019 and 2020. Demographic and medical data were retrieved from electronic medical charts. Causes of death were specifically categorised. We applied statistical models to test for differences in mortality using incidence rate ratio (IRR) according to the day, time and cause of death.
RESULTS
One thousand, two hundred and seventy-eight deceased patients were included. All-cause mortality was similar between weekends and weekdays. When sepsis was the cause of death, higher IRR were demonstrated on Fridays in comparison with weekdays (IRR 1.4; 95% confidence interval (CI) 1.1-1.9; P < 0.05). Other causes of death were not consistent with a 'weekend effect'. Mortality during night shifts was higher in comparison with the afternoon (IRR 1.5; 95% CI 1.3-4.7) and similar to the morning (IRR 1; 95% CI 0.9-1.2).
CONCLUSION
Our study did not find a pattern of 'weekend effect' or 'night effect' on all-cause mortality among hospitalised patients in internal medicine wards. Our findings suggest that perhaps specifically death from sepsis, and not all-cause mortality, can be used as a surrogate for the measurement of understaffing or quality of care in the internal ward.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1240-1247Informations de copyright
© 2022 Royal Australasian College of Physicians.
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.
Lilford RJ, Chen Y-F. The ubiquitous weekend effect: moving past proving it exists to clarifying what causes it. BMJ Qual Saf 2015; 24: 480-2.
Coiera E, Wang Y, Magrabi F, Concha OP, Gallego B, Runciman W. Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks. BMC Health Serv Res 2014; 14: 226.
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.
Fang J, Saposnik G, Silver FL, Kapral MK, Investigators of the Registry of the Canadian Stroke Network. Association between weekend hospital presentation and stroke fatality. Neurology 2010; 75: 1589-96.
James MT, Wald R, Bell CM, Tonelli M, Hemmelgarn BR, Waikar SS et al. Weekend hospital admission, acute kidney injury, and mortality. J Am Soc Nephrol 2010; 21: 845-51.
Aujesky D, Jiménez D, Mor MK, Geng M, Fine MJ, Ibrahim SA. Weekend versus weekday admission and mortality following acute pulmonary embolism. Circulation 2009; 119: 962-8.
Han L, Sutton M, Clough S, Warner R, Doran T. Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital. BMJ Qual Saf 2018; 27: 445-54.
Aldridge C, Bion J, Boyal A, Chen Y-F, Clancy M, Evans T et al. Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. Lancet 2016; 388: 178-86.
Ensminger SA, Morales IJ, Peters SG, Keegan MT, Finkielman JD, Lymp JF et al. The hospital mortality of patients admitted to the ICU on weekends. Chest 2004; 126: 1292-8.
Li L, Rothwell PM. Biases in detection of apparent “weekend effect” on outcome with administrative coding data: population based study of stroke. BMJ 2016; 353: i2648.
Bray BD, Cloud GC, James MA, Hemingway H, Paley L, Stewart K et al. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. Lancet 2016; 388: 170-7.
Portaluppi F, Tiseo R, Smolensky MH, Hermida RC, Ayala DE, Fabbian F. Circadian rhythms and cardiovascular health. Sleep Med Rev 2012; 16: 151-66.
Manfredini R, Boari B, Bressan S, Gallerani M, Salmi R, Portaluppi F et al. Influence of circadian rhythm on mortality after myocardial infarction: data from a prospective cohort of emergency calls. Am J Emerg Med 2004; 22: 555-9.
Galloway M, Hegarty A, McGill S, Arulkumaran N, Brett SJ, Harrison D. The effect of ICU out-of-hours admission on mortality: a systematic review and meta-analysis. Crit Care Med 2018; 46: 290-9.
Cunningham SA, Mitchell K, Venkat Narayan KM, Yusuf S. Doctors' strikes and mortality: a review. Soc Sci Med 2008; 67: 1784-8.
Deng W, Zhu S, Zeng L, Liu J, Kang R, Yang M et al. The circadian clock controls immune checkpoint pathway in sepsis. Cell Rep 2018; 24: 366-78.
Vicent L, González-Casal D, Bruña V, Devesa C, García-Carreño J, Sousa-Casasnovas I et al. Circadian rhythm of deaths in a cardiology department: a five-year analysis. CRD 2020; 145: 344-9.
Cohen MC, Rohtla KM, Lavery CE, Muller JE, Mittleman MA. Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol 1997; 79: 1512-6.
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.
Scheff JD, Calvano SE, Lowry SF, Androulakis IP. Modeling the influence of circadian rhythms on the acute inflammatory response. J Theor Biol 2010; 264: 1068-76.
Zajic P, Bauer P, Rhodes A, Moreno R, Fellinger T, Metnitz B et al. Time of day and its association with risk of death and chance of discharge in critically ill patients: a retrospective study. Sci Rep 2019; 9: 12533.
Marco J, Barba R, Plaza S, Losa JE, Canora J, Zapatero A. Analysis of the mortality of patients admitted to internal medicine wards over the weekend. Am J Med Qual 2010; 25: 312-8.
Arulkumaran N, Harrison DA, Brett SJ. Association between day and time of admission to critical care and acute hospital outcome for unplanned admissions to adult general critical care units: cohort study exploring the ‘weekend effect’. Br J Anaesth 2017; 118: 112-22.
Bray BD, Ayis S, Campbell J, Cloud GC, James M, Hoffman A et al. Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. PLoS Med 2014; 11: e1001705.
Baldwin HJ, Marashi-Pour S, Chen H-Y, Kaldor J, Sutherland K, Levesque J-F. Is the weekend effect really ubiquitous? A retrospective clinical cohort analyses of 30-day mortality by day of week and time of day using linked population data from New South Wales, Australia. BMJ Open 2018; 8: e016943.
Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002; 288: 2151-62.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304-77.
Freemantle N, Richardson M, Wood J, Ray D, Khosla S, Shahian D et al. Weekend hospitalization and additional risk of death: an analysis of inpatient data. J R Soc Med 2012; 105: 74-84.
Ju T, Al-Mashat M, Rivas L, Sarani B. Sepsis rapid response teams. Crit Care Clin 2018; 34: 253-8.
Umscheid CA, Betesh J, VanZandbergen C, Hanish A, Tait G, Mikkelsen ME et al. Development, implementation, and impact of an automated early warning and response system for sepsis. J Hosp Med 2015; 10: 26-31.
Guirgis FW, Jones L, Esma R, Weiss A, McCurdy K, Ferreira J et al. Managing sepsis: electronic recognition, rapid response teams, and standardized care save lives. J Crit Care 2017; 40: 296-302.