在择期治疗环境中，与急诊环境相比，周末住院与更高的死亡风险相关：一项对英国国民保健制度医院的回顾性数据库研究。

Weekend admission to hospital has a higher risk of death in the elective setting than in the emergency setting: a retrospective database study of national health service hospitals in England.

机构信息

Primary Care Clinical Sciences, University of Birmingham, Birmingham, England, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.

出版信息

BMC Health Serv Res. 2012 Apr 2;12:87. doi: 10.1186/1472-6963-12-87.

DOI:10.1186/1472-6963-12-87

PMID:22471933

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3341193/

Abstract

BACKGROUND

Although acute hospitals offer a twenty-four hour seven day a week service levels of staffing are lower over the weekends and some health care processes may be less readily available over the weekend. Whilst it is thought that emergency admission to hospital on the weekend is associated with an increased risk of death, the extent to which this applies to elective admissions is less well known. We investigated the risk of death in elective and elective patients admitted over the weekend versus the weekdays.

METHODS

Retrospective statistical analysis of routinely collected acute hospital admissions in England, involving all patient discharges from all acute hospitals in England over a year (April 2008-March 2009), using a logistic regression model which adjusted for a range of patient case-mix variables, seasonality and admission over a weekend separately for elective and emergency (but excluding zero day stay emergency admissions discharged alive) admissions.

RESULTS

Of the 1,535,267 elective admissions, 91.7% (1,407,705) were admitted on the weekday and 8.3% (127,562) were admitted on the weekend. The mortality following weekday admission was 0.52% (7,276/1,407,705) compared with 0.77% (986/127,562) following weekend admission. Of the 3,105,249 emergency admissions, 76.3% (2,369,316) were admitted on the weekday and 23.7% (735,933) were admitted on the weekend. The mortality following emergency weekday admission was 6.53% (154,761/2,369,316) compared to 7.06% (51,922/735,933) following weekend admission. After case-mix adjustment, weekend admissions were associated with an increased risk of death, especially in the elective setting (elective Odds Ratio: 1.32, 95% Confidence Interval 1.23 to 1.41); vs emergency Odds Ratio: 1.09, 95% Confidence Interval 1.05 to 1.13).

CONCLUSIONS

Weekend admission appears to be an independent risk factor for dying in hospital and this risk is more pronounced in the elective setting. Given the planned nature of elective admissions, as opposed to the unplanned nature of emergency admissions, it would seem less likely that this increased risk in the elective setting is attributable to unobserved patient risk factors. Further work to understand the relationship between weekend processes of care and mortality, especially in the elective setting, is required.

摘要

背景

尽管急症医院提供每周七天、每天 24 小时的服务，但周末的人员配备水平较低，一些医疗流程在周末可能不太容易获得。虽然人们认为周末紧急入院与死亡风险增加有关，但这种情况在择期入院中的程度尚不清楚。我们调查了周末和工作日择期和择期入院患者的死亡风险。

方法

对英格兰常规收集的急性医院入院情况进行回顾性统计分析，涉及英格兰所有急性医院在一年中的所有患者出院情况（2008 年 4 月至 2009 年 3 月），使用逻辑回归模型，该模型调整了一系列患者病例组合变量、季节性和周末分别为紧急（但不包括零天住院的紧急出院存活）入院和择期入院。

结果

在 1535267 例择期入院中，91.7%（1407705 例）在工作日入院，8.3%（127562 例）在周末入院。工作日入院后死亡率为 0.52%（7276/1407705），而周末入院后死亡率为 0.77%（986/127562）。在 3105249 例紧急入院中，76.3%（2369316 例）在工作日入院，23.7%（735933 例）在周末入院。紧急工作日入院后死亡率为 6.53%（154761/2369316），而周末入院后死亡率为 7.06%（51922/735933）。在病例组合调整后，周末入院与死亡风险增加相关，尤其是在择期治疗中（择期比值比：1.32，95%置信区间 1.23 至 1.41）；与急诊相比比值比：1.09，95%置信区间 1.05 至 1.13）。