Department of Colon and Rectal Surgery, Lahey Clinic, Tufts University, 41 Mall Rd, Burlington, MA 01805, USA.
BMC Med Educ. 2014 Jan 8;14:4. doi: 10.1186/1472-6920-14-4.
Several studies have demonstrated increased inhospital mortality following weekend admission. We hypothesized that the presence of resident trainees reduces the weekend mortality trends.
We identified all patients with a non-elective hospital admission from 1/1/2003 through 12/31/2008. We abstracted vital status on discharge and calculated the Charlson comorbidity score for all inpatients. We compared odds of inpatient mortality following non-elective admission on a weekend day as compared to a weekday, while considering diagnosis, patient characteristics, comorbidity, hospital factors, and care at hospitals with resident trainees.
Data were available for 48,253,968 patient discharges during the six-year study period. The relative risk of mortality was 15% higher following weekend admission as compared to weekday admission. After adjusting for diagnosis, age, sex, race, income level, payer, comorbidity, and weekend admission the overall odds of mortality was higher for patients in hospitals with fewer nurses and staff physicians. Mortality following a weekend admission for patients admitted to a hospital with resident trainees was significantly higher (17%) than hospitals with no resident trainees (p < 0.001).
Low staffing levels of nurses and physicians significantly impact mortality on weekends following non-elective admission. Conversely, patients admitted to hospitals with more resident trainees had significantly higher mortality following a weekend admission.
多项研究表明，周末入院后住院死亡率增加。我们假设住院医师的存在降低了周末死亡率的趋势。
我们确定了 2003 年 1 月 1 日至 2008 年 12 月 31 日期间所有非择期住院患者。我们摘录了出院时的生存状况，并为所有住院患者计算了 Charlson 合并症评分。我们比较了周末和工作日非择期入院后住院死亡率的比值，同时考虑了诊断、患者特征、合并症、医院因素以及住院医师所在医院的护理情况。
在六年的研究期间，有 48253968 名患者出院的数据可用。与工作日入院相比，周末入院的死亡率相对风险增加 15%。在调整诊断、年龄、性别、种族、收入水平、支付者、合并症和周末入院后，护士和工作人员医生人数较少的医院的患者死亡率总体较高。与没有住院医师的医院相比，有住院医师的医院周末收治的患者死亡率明显更高（17%）（p < 0.001）。
护士和医生的低人员配备水平显著影响非择期入院后周末的死亡率。相反，周末收治在住院医师较多的医院的患者死亡率明显更高。
