Open AccessThe increased mortality associated with a weekend emergency admission is due to increased illness severity and altered case-mix
Author(s) -
Olga Mikulich,
Elizabeth Callaly,
Kimberly Statler Bennett,
Deirdre O’Riordan,
Bernard Silke
Publication year - 2011
Publication title -
acute medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.14
H-Index - 12
eISSN - 1747-4892
pISSN - 1747-4884
DOI - 10.52964/amja.0507
Subject(s) - medicine , weekend effect , logistic regression , hospital admission , odds ratio , emergency medicine , emergency department , univariate analysis , odds , multivariate analysis , case mix index , severity of illness , pediatrics , nursing , psychiatry
Background: A weekend emergency medical admission has been associated with a higher mortality. We have examined all weekend admissions to St James’ Hospital, Dublin between 2002 and 2009. Methods: We divided admissions by weekday or weekend (Saturday or Sunday) presentation. We utilised a multivariate logistic model, to determine whether a weekend admission was independently predictive of 30 day outcome. Results: There were 49337 episodes recorded in 25883 patients; 30-day inhospital mortality at the weekend (9.9% vs. 9.0%) had an unadjusted Odds Ratio of 1.11 (95% CI 0.99, 1.23: p=0.057). In the full risk (unlike the univariate) model, a weekend admission was not independently predictive (OR 1.05; 95% CI: 0.88, 1.24). The case-mix for a weekend admission differed; with more neurological diagnoses (22.8% vs 20.4% : p = 0.001) and less gastrointestinal disease (18.3% vs 21.1% : p = 0.001). A biochemistry only illness severity score predicted a higher mortality for weekend admissions. Conclusion: Patients admitted at the weekend had an approximate 11% increased 30-day in-hospital mortality, compared with a weekday admission. However, admission at the weekend was not independently predictive in a risk model that included Illness Severity (age and biochemical markers) and co-morbidity. Sicker patients, with a worse outcome, are admitted over the weekend; these considerations should inform the allocation of healthcare resources.