The impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospitalCitation formats

  • Authors:
  • Lu Han
  • Matt Sutton
  • Stuart Clough
  • Richard Warner
  • Tim Doran

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The 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.

In: BMJ Quality and Safety, Vol. 27, No. 6, 06.2018, p. 445-454.

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Han, Lu ; Sutton, Matt ; Clough, Stuart ; Warner, Richard ; Doran, Tim. / The impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital. In: BMJ Quality and Safety. 2018 ; Vol. 27, No. 6. pp. 445-454.

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@article{d846fb2657cf4f978b3c6df079f5b59f,
title = "The impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital",
abstract = "BackgroundEmergency hospital admission at 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 dataset to estimate the ‘weekend effect’ over time and the effect of night-time admission on the mortality rate. MethodWe 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 of two key predictors on mortality: i) admission at weekends (7.00 pm Friday to 6.59 am Monday); ii) night-time admission (7.00 pm to 6.59 am). Logistic regressions were estimated to produce odds ratios. ResultsCrude 30-day mortality rate decreased from 6.6{\%} in 2004/05 to 5.2{\%} in 2013/14. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission at weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.168), 7-day mortality by 0.4 percentage points (adjusted OR: 1.225), and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.140) compared with admission on weekday day-times. 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 at weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night at 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.",
author = "Lu Han and Matt Sutton and Stuart Clough and Richard Warner and Tim Doran",
year = "2018",
month = "6",
doi = "10.1136/bmjqs-2017-006784",
language = "English",
volume = "27",
pages = "445--454",
journal = "BMJ Quality and Safety",
issn = "2044-5415",
publisher = "BMJ",
number = "6",

}

RIS

TY - JOUR

T1 - The impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital

AU - Han, Lu

AU - Sutton, Matt

AU - Clough, Stuart

AU - Warner, Richard

AU - Doran, Tim

PY - 2018/6

Y1 - 2018/6

N2 - BackgroundEmergency hospital admission at 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 dataset to estimate the ‘weekend effect’ over time and the effect of night-time admission on the mortality rate. MethodWe 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 of two key predictors on mortality: i) admission at weekends (7.00 pm Friday to 6.59 am Monday); ii) night-time admission (7.00 pm to 6.59 am). Logistic regressions were estimated to produce odds ratios. ResultsCrude 30-day mortality rate decreased from 6.6% in 2004/05 to 5.2% in 2013/14. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission at weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.168), 7-day mortality by 0.4 percentage points (adjusted OR: 1.225), and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.140) compared with admission on weekday day-times. 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 at weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night at 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.

AB - BackgroundEmergency hospital admission at 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 dataset to estimate the ‘weekend effect’ over time and the effect of night-time admission on the mortality rate. MethodWe 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 of two key predictors on mortality: i) admission at weekends (7.00 pm Friday to 6.59 am Monday); ii) night-time admission (7.00 pm to 6.59 am). Logistic regressions were estimated to produce odds ratios. ResultsCrude 30-day mortality rate decreased from 6.6% in 2004/05 to 5.2% in 2013/14. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission at weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.168), 7-day mortality by 0.4 percentage points (adjusted OR: 1.225), and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.140) compared with admission on weekday day-times. 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 at weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night at 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.

U2 - 10.1136/bmjqs-2017-006784

DO - 10.1136/bmjqs-2017-006784

M3 - Article

VL - 27

SP - 445

EP - 454

JO - BMJ Quality and Safety

JF - BMJ Quality and Safety

SN - 2044-5415

IS - 6

ER -