ABSTRACT
RATIONALE, AIMS, AND OBJECTIVES: A reduction in the provision of hospital services on the weekend probably explains higher mortality for patients who are either admitted to hospital or undergo procedures on the weekend. The aim was to examine the effect of the day of the week of admission (DOWOA) upon the efficiency and quality of care for a cohort of General Medical inpatients. METHODS: Electronic records were selected for unplanned adult admissions to 2 large public hospitals in Adelaide, South Australia, July 2012 to June 2017. RESULTS: The cohort consisted of 50 323 records. The number of admissions on each day of the week differed significantly from 6389 on Sundays to 7548 on Thursdays (P < 0.001). Discharges were most frequent on Fridays, and fewest occurred on weekends (P < 0.001) especially if aged over 80 years, if they had significant comorbidity or if they were discharged to a residential aged care facility. The DOWOA did not significantly influence the proportion of cases who died in hospital (5.6% to 6.4%; P = 0.47). The DOWOA significantly affected median inpatient length of stay (IPLOS; 3.1 to 3.9 days; P < 0.001). The median inpatient length of stay (IPLOS) matched the number of days from the ensuing weekend to the DOWOA with the longest median IPLOS. CONCLUSIONS: General Medicine has an inpatient mortality unaffected by the DOWOA. Care efficiency, however, follows a weekly cycle. The "weekend effect" for General Medical inpatients is a prolongation in their IPLOS as a result of fewer weekend discharges.
Subject(s)
Hospitalization/statistics & numerical data , Hospitals, General , Patient Care Management , Patient Discharge/standards , Adult , Aged, 80 and over , Australia , Delivery of Health Care/organization & administration , Female , Hospital Mortality , Hospitals, General/organization & administration , Hospitals, General/standards , Hospitals, General/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Needs Assessment , Patient Care Management/organization & administration , Patient Care Management/standards , Patient Readmission/statistics & numerical data , Time FactorsABSTRACT
OBJECTIVE: To determine the 30 day major adverse cardiac events (MACE) and re-presentation rates of non-specific chest pain (NSCP) patients following four different disposition pathways and to contrast re-presentation rates of patients with NSCP with those for all other patients presenting to the ED. METHODS: Cases were derived from the ED database for two large teaching hospitals where patients aged 18 or over were triaged between 2009 and 2016, and their diagnosis on leaving the ED was NSCP. Statewide 30 day rates of MACE and ED re-presentations were calculated, and multivariable logistic regression analysis identified significant predictors of both. RESULTS: A total of 40 183 cases were included; 16 014 discharged directly from the ED, while the remainder were admitted under Cardiology (n = 7286), General Medicine (n = 7739) or an ED observation unit (n = 4086). Compared to discharge directly from the ED, admission was associated with a decreased 30 day re-presentation rate (OR = 0.857; 95% CI 0.795-0.923; P < 0.001). However, there was no significant difference in adjusted re-presentation between admitting units. The rates of 30 day MACE were higher in admitted patients, particularly in those admitted to general medicine; however, this difference was accounted for by differing patient characteristics. CONCLUSION: Despite a slightly increased rate of re-presentation in patients with NSCP sent home from the ED, we conclude that there is minimal advantage in admitting many patients who lack a diagnosis for their chest pain. For a selected patient population, discharge from the ED may become a safe and cost-effective approach. A prospective randomised study is required.
