Don't get sick on the weekend: an evaluation of the weekend effect on mortality for patients visiting US EDs

  • Adam L. Sharp
    Corresponding author. The Robert Wood Johnson Foundation Clinical Scholars Program, North Campus Research Center (NCRC), Ann Arbor, MI 48109–2800, USA.
    Department of Emergency Medicine, Robert Wood Johnson Foundation Clinical Scholar, University of Michigan, Ann Arbor, MI 48109–2800, USA
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  • HwaJung Choi
    Department of Internal Medicine, Robert Wood Johnson Clinical Scholar Program, University of Michigan, Ann Arbor, MI 48109–2800, USA
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  • Rod A. Hayward
    Department of Internal Medicine and Veteran Affairs HSR&D, Robert Wood Johnson Clinical Scholar Program, University of Michigan, Ann Arbor, MI 48109–2800, USA
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Published:March 04, 2013DOI:


      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.


      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.


      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.


      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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