McAlister Finlay A, Youngson Erik, Padwal Raj S, Majumdar Sumit R
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada; Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada.
J Hosp Med. 2015 Feb;10(2):69-74. doi: 10.1002/jhm.2310. Epub 2014 Dec 24.
Hospitals reduce staffing levels and services on weekends. This raises the question of whether weekend discharges may be inadequately prepared and thus at higher risk for adverse events postdischarge.
To compare death or nonelective readmission rates 30 days after weekend versus weekday discharge.
Retrospective cohort.
All teaching hospitals in Alberta, Canada.
General internal medicine (GIM) discharges (only 1 per patient).
Analyses were adjusted for demographics, comorbidity, and length of stay based on a previously validated index.
Of 7991 patients (mean age, 62.1 years; 51.9% male; mean Charlson 2.56; 57.5% LACE ≥10) discharged from 7 teaching hospitals, 1146 (14.3%) were discharged on a weekend. Although they had substantially shorter lengths of stay (5.64 days, 95% confidence interval [CI]: 5.35-5.93 vs 7.86 days, 95% CI: 7.71-8.00, adjusted P value < 0.0001) and were less likely to be discharged with homecare support (10.9% vs 19.3%) or to long-term care facilities (3.1% vs 7.8%), patients discharged on weekends exhibited similar rates of death or readmission at 30 days compared to those discharged on weekdays (10.6% vs 13.2%, adjusted odds ratio [aOR]: 0.94, 95% CI: 0.77-1.16), even among the 4591 patients deemed to be at high risk for postdischarge events based on LACE (length of hospital stay, acuity of admission, comorbidity burden quantified using the Charlson Comorbidity Index, and emergency department visits in the 6 months prior to admission) score ≥10 (16.8% vs 16.5% for weekday discharges, aOR: 1.09 [95% CI: 0.85-1.41]).
GIM patients discharged from teaching hospitals on weekends have shorter lengths of stay and exhibit similar postdischarge outcomes as patients discharged on weekdays.
医院在周末会减少人员配备水平和服务。这就引发了一个问题，即周末出院的患者是否准备不足，因此出院后发生不良事件的风险更高。
比较周末出院与工作日出院后30天的死亡率或非选择性再入院率。
回顾性队列研究。
加拿大艾伯塔省的所有教学医院。
普通内科（GIM）出院患者（每位患者仅1次）。
根据先前验证的指数，对人口统计学、合并症和住院时间进行分析调整。
在7家教学医院出院的7991例患者（平均年龄62.1岁；51.9%为男性；平均Charlson评分为2.56；57.5%的LACE评分≥10）中，1146例（14.3%）在周末出院。尽管他们的住院时间明显较短（5.64天，95%置信区间[CI]：5.35 - 5.93天，而工作日出院患者为7.86天，95%CI：7.71 - 8.00天，调整后P值<0.0001），且出院时获得家庭护理支持（10.9%对19.3%）或转至长期护理机构（3.1%对7.8%）的可能性较小，但周末出院的患者在30天时的死亡或再入院率与工作日出院的患者相似（10.6%对13.2%，调整后比值比[aOR]：0.94，95%CI：0.77 - 1.16），即使在根据LACE（住院时间、入院急症程度、使用Charlson合并症指数量化的合并症负担以及入院前6个月内的急诊科就诊次数）评分≥10被认为出院后事件高风险的4591例患者中也是如此（工作日出院患者为16.8%，周末出院患者为16.5%，aOR：1.09 [95%CI：0.85 - 1.41]）。
教学医院周末出院的GIM患者住院时间较短，出院后的结局与工作日出院的患者相似。
