Bendavid Eran, Kaganova Yevgenia, Needleman Jack, Gruenberg Leonard, Weissman Joel S
Center for Health Policy, Stanford Medical School, Stanford, Calif 94305, USA.
Am J Med. 2007 May;120(5):422-8. doi: 10.1016/j.amjmed.2006.05.067.
Recent studies and anecdotal evidence suggest that patient safety may be compromised on weekends. Our objective was to determine whether rates of complications in hospitals are higher on weekends than on weekdays.
We examined records from 4,967,114 admissions to acute care hospitals in 3 states and analyzed complication rates using the Patient Safety Indicators. We selected 8 indicators that could be assigned to a single day: complications of anesthesia, retained foreign bodies, postoperative hemorrhage, accidental cuts and lacerations during procedures, birth trauma, obstetric trauma during vaginal deliveries with and without instrumentation, and obstetric trauma during cesarean delivery. Odds ratios (ORs) comparing weekends versus weekdays were adjusted for demographics, type of admission, and admission route. In a subgroup analysis of surgical complications, we restricted the population to patients who underwent cardiac or vascular procedures.
Four of the 8 complications occurred more frequently on weekends: postoperative hemorrhage (OR 1.07, 95% confidence interval [CI], 1.01-1.14), newborn trauma (OR 1.06, 95% CI, 1.03-1.10), vaginal deliveries without instrumentation (OR 1.03, 95% CI, 1.02-1.04), and obstetric trauma during cesarean sections (OR 1.36, 95% CI, 1.29-1.44). Complications related to anesthesia occurred less frequently on weekends (OR 0.86). Among patients undergoing vascular procedures, surgical complications occurred more frequently on weekends (OR 1.46, 95% CI, 1.16-1.85).
Rates of complications are marginally higher on weekends than on weekdays for some surgical and newborn complications, but more significantly for obstetric trauma and for surgical complications involving patients undergoing vascular procedures. Hospitals should work toward increasing the robustness of safeguards on weekends.
近期的研究和传闻证据表明，周末患者安全可能受到影响。我们的目标是确定医院并发症发生率在周末是否高于工作日。
我们检查了三个州4967114例急性护理医院住院患者的记录，并使用患者安全指标分析并发症发生率。我们选择了8个可归为某一天的指标：麻醉并发症、异物残留、术后出血、手术过程中的意外切割和撕裂伤、出生创伤、有无器械辅助的阴道分娩时的产科创伤以及剖宫产时的产科创伤。比较周末与工作日的比值比（OR）针对人口统计学特征、入院类型和入院途径进行了调整。在手术并发症的亚组分析中，我们将研究人群限制为接受心脏或血管手术的患者。
8种并发症中有4种在周末发生得更频繁：术后出血（OR 1.07，95%置信区间[CI]，1.01 - 1.14）、新生儿创伤（OR 1.06，95% CI，1.03 - 1.10）、无器械辅助的阴道分娩（OR 1.03，95% CI，1.02 - 1.04）以及剖宫产时的产科创伤（OR 1.36，95% CI，1.29 - 1.44）。与麻醉相关的并发症在周末发生得较少（OR 0.86）。在接受血管手术的患者中，手术并发症在周末发生得更频繁（OR 1.46，95% CI，1.16 - 1.85）。
对于某些手术和新生儿并发症，周末的并发症发生率略高于工作日，但对于产科创伤以及涉及接受血管手术患者的手术并发症而言，差异更为显著。医院应努力提高周末保障措施的稳健性。
