Vest-Hansen Betina, Riis Anders Hammerich, Sørensen Henrik Toft, Christiansen Christian Fynbo
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
BMJ Open. 2015 Mar 11;5(3):e006731. doi: 10.1136/bmjopen-2014-006731.
Knowledge on timing of admissions and mortality for acute medical patients is limited. The aim of the study was to examine hospital admission rates and mortality rates for patients with common medical conditions according to time of admission.
Nationwide population-based cohort study.
Population of Denmark.
Using the Danish National Registry of Patients covering all Danish hospitals, we identified all adults with the first acute admission to a medical department in Denmark during 2010.
Hourly admission rates and age-standardised and sex-standardised 30-day mortality rates comparing weekday office hours, weekday out of hours, weekend daytime hours and weekend night-time hours.
In total, 174,192 acute medical patients were included in the study. The admission rates (patients per hour) were 38.7 (95% CI 38.4 to 38.9) during weekday office hours, 13.3 (95% CI 13.2 to 13.5) during weekday out of hours, 19.8 (95% CI 19.6 to 20.1) during weekend daytime hours and 7.9 (95% CI 7.8 to 8.0) during weekend night-time hours. Admission rates varied between medical conditions. The proportion of patients admitted to an intensive care unit (ICU) increased outside of office hours. The age-standardised and sex-standardised 30-day mortality rate was 5.1% (95% CI 5.0% to 5.3%) after admission during weekday office hours, 5.7% (95% CI 5.5% to 6.0%) after admission during weekday out of hours, 6.4% (95% CI 6.1% to 6.7%) after admission during weekend daytime hours and 6.3% (95% CI 5.9% to 6.8%) after admission during weekend night-time hours. For the majority of the medical conditions examined, weekend admission was associated with highest mortality.
While admission rates decreased from office hours to weekend hours there was an observed increase in mortality. This may reflect differences in severity of illness as the proportion admitted to an ICU increased during the weekend.
关于急性内科患者的入院时间和死亡率的知识有限。本研究的目的是根据入院时间来研究常见内科疾病患者的住院率和死亡率。
基于全国人口的队列研究。
丹麦人口。
利用涵盖丹麦所有医院的丹麦国家患者登记处，我们确定了2010年期间首次急性入住丹麦某内科的所有成年人。
比较工作日办公时间、工作日非办公时间、周末白天时间和周末夜间时间的每小时入院率以及年龄标准化和性别标准化的30天死亡率。
本研究共纳入174192例急性内科患者。工作日办公时间的入院率（每小时患者数）为38.7（95%CI 38.4至38.9），工作日非办公时间为13.3（95%CI 13.2至13.5），周末白天时间为19.8（95%CI 19.6至20.1），周末夜间时间为7.9（95%CI 7.8至8.0）。不同内科疾病的入院率有所不同。非办公时间入住重症监护病房（ICU）的患者比例增加。工作日办公时间入院后的年龄标准化和性别标准化30天死亡率为5.1%（95%CI 5.0%至5.3%），工作日非办公时间入院后为5.7%（95%CI 5.5%至6.0%），周末白天时间入院后为6.4%（95%CI 6.1%至6.7%），周末夜间时间入院后为6.3%（95%CI 5.9%至6.8%）。对于大多数所研究的内科疾病而言，周末入院与最高死亡率相关。
虽然从办公时间到周末时间入院率下降，但观察到死亡率有所上升。这可能反映了疾病严重程度的差异，因为周末期间入住ICU的患者比例增加。
