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Exploratory study of the 'weekend effect' for acute medical admissions to public hospitals in Queensland, Australia.
Intern Med J. 2010 Nov; 40(11):777-83.IM

Abstract

AIMS

To determine whether in-hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the 'weekend effect').

METHODS

We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003-2006/2007 financial years. The primary outcome was 30-day in-hospital mortality. The secondary outcome of 2-day in-hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care.

RESULTS

During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30-day in-hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81-1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86-1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54-1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03-1.26, P= 0.007). Two-day in-hospital mortality showed similar results.

CONCLUSION

This is the first Australian study on the 'weekend effect' (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia.

Authors+Show Affiliations

School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. melissaclarky@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19811554

Citation

Clarke, M S., et al. "Exploratory Study of the 'weekend Effect' for Acute Medical Admissions to Public Hospitals in Queensland, Australia." Internal Medicine Journal, vol. 40, no. 11, 2010, pp. 777-83.
Clarke MS, Wills RA, 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(11):777-83.
Clarke, M. S., Wills, R. A., Bowman, R. V., Zimmerman, P. V., Fong, K. M., Coory, M. D., & Yang, I. A. (2010). Exploratory study of the 'weekend effect' for acute medical admissions to public hospitals in Queensland, Australia. Internal Medicine Journal, 40(11), 777-83. https://doi.org/10.1111/j.1445-5994.2009.02067.x
Clarke MS, et al. Exploratory Study of the 'weekend Effect' for Acute Medical Admissions to Public Hospitals in Queensland, Australia. Intern Med J. 2010;40(11):777-83. PubMed PMID: 19811554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exploratory study of the 'weekend effect' for acute medical admissions to public hospitals in Queensland, Australia. AU - Clarke,M S, AU - Wills,R-A, AU - Bowman,R V, AU - Zimmerman,P V, AU - Fong,K M, AU - Coory,M D, AU - Yang,I A, PY - 2009/10/9/entrez PY - 2009/10/9/pubmed PY - 2011/10/1/medline SP - 777 EP - 83 JF - Internal medicine journal JO - Intern Med J VL - 40 IS - 11 N2 - AIMS: To determine whether in-hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the 'weekend effect'). METHODS: We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003-2006/2007 financial years. The primary outcome was 30-day in-hospital mortality. The secondary outcome of 2-day in-hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care. RESULTS: During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30-day in-hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81-1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86-1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54-1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03-1.26, P= 0.007). Two-day in-hospital mortality showed similar results. CONCLUSION: This is the first Australian study on the 'weekend effect' (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia. SN - 1445-5994 UR - https://www.unboundmedicine.com/medline/citation/19811554/Exploratory_study_of_the_'weekend_effect'_for_acute_medical_admissions_to_public_hospitals_in_Queensland_Australia_ L2 - https://doi.org/10.1111/j.1445-5994.2009.02067.x DB - PRIME DP - Unbound Medicine ER -