Abstract
Primary objective
The primary objective of the study is to determine if the mortality for adult patients
visiting US emergency departments (EDs) is greater on weekends than weekdays.
Secondary objectives
The secondary objective of the study is to examine whether patient factors (diagnosis,
income, insurance status) or hospital characteristics (ownership, ED volume, teaching
status) are associated with increased weekend mortality.
Methods
We used a retrospective cohort analysis of the 2008 Nationwide Emergency Department
Sample. Evaluating 4225973 adults admitted through the ED to the hospital, signifying a 20% representative
sample of US ED admissions. Logistic regression was used to examine associations of
weekend mortality with patient and hospital characteristics, accounting for clustering
by hospital.
Results
Emergency department patients admitted to the hospital on the weekend are significantly
more likely to die than those admitted on weekdays (odds ratio, 1.073; 95% confidence
interval, 1.061-1.084). A significant weekend effect persisted after controlling for
patient characteristics (odds ratio, 1.026; 95% confidence interval, 1.005-1.048).
The top 10 primary diagnoses for patients dying did not identify any specific medical
condition that explained the higher weekend admission mortality. The weekend effect
was also relatively consistent across patient income, insurance status, hospital ownership,
ED volume, and hospital teaching status.
Conclusion
Patients are more likely to die when admitted through the ED on the weekend. We were
unable to identify specific circumstances or hospital attributes that help explain
this phenomenon. Although the relative increased risk per case is small, our study
demonstrates a significant number of potentially preventable weekend deaths occurring
annually in the United States.
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Article Info
Publication History
Published online: March 04, 2013
Accepted:
January 10,
2013
Received:
December 12,
2012
Footnotes
☆Data set: The Nationwide Emergency Department Sample used for analysis is publicly available and was previously de-identified by the Agency for Healthcare Research and Quality.
☆☆Financial Support: ALS is supported by the Robert Wood Johnson Foundation Clinical Scholar Program.
★Disclosures/conflicts of interest: No authors have conflicts of interest to report.
★★Prior Presentation: A poster for this study was presented at the American College of Emergency Physicians Scientific Assembly in Denver Colorado October 2012.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
