非工作时间收治对患者死亡率的影响：一家三级急症医院的纵向分析。
Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital.
机构信息
Department of Health Sciences, University of York, York, UK.
Manchester Centre for Health Economics, University of Manchester, Manchester, UK.
出版信息
BMJ Qual Saf. 2018 Jun;27(6):445-454. doi: 10.1136/bmjqs-2017-006784. Epub 2017 Sep 29.
BACKGROUND
Emergency hospital admission on weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day-not time-of admission. We used an enhanced longitudinal data set to estimate the 'weekend effect' over time and the effect of night-time admission on all-cause mortality rates.
METHODS
We examined 246 350 emergency spells from a large teaching hospital in England between April 2004 and March 2014. Outcomes included 7-day, 30-day and in-hospital mortality rates. We conducted probit regressions to estimate the impact on the absolute difference in the risk of mortality of two key predictors: (1) admission on weekends (19:00 Friday to 06:59 Monday); and (2) night-time admission (19:00 to 06:59). Logistic regressions were used to estimate ORs for relative mortality risk differences.
RESULTS
Crude 30-day mortality rate decreased from 6.6% in 2004/2005 to 5.2% in 2013/2014. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission on weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.17, 95% CI 1.10 to 1.25), 7-day mortality by 0.5 percentage points (adjusted OR: 1.23, 95% CI 1.12 to 1.34) and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.14, 95% CI 1.08 to 1.21) compared with admission on weekday daytimes. Weekend night-time admission was associated with increased mortality risk in 9 out of 10 years, but this was only statistically significant (p<0.05) in 5 out of 10 years.
CONCLUSIONS
There is an increased risk of mortality for patients admitted as emergencies both on weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night on weekends. This increased risk appears to be consistent over time, but the effects are small and are not statistically significant in individual hospitals in every year.
背景
周末急诊入院与死亡率升高相关。既往研究仅局限于考察单一年份，并评估日间-而非具体时间-入院的影响。我们采用增强型纵向数据集来随时间估算“周末效应”，以及夜间入院对全因死亡率的影响。
方法
我们分析了英格兰一家大型教学医院在 2004 年 4 月至 2014 年 3 月期间的 246350 例急诊就诊。结局包括 7 天、30 天和院内死亡率。我们进行概率回归来估计两个关键预测因素的绝对死亡率差异的影响：（1）周末入院（19:00 周五至 06:59 周一）；（2）夜间入院（19:00 至 06:59）。我们采用逻辑回归来估计相对死亡率风险差异的比值比。
结果
未经调整的 30 天死亡率从 2004/2005 年的 6.6%下降至 2013/2014 年的 5.2%。所有非工作时间的调整后死亡率风险均升高。风险最高的是周末夜间入院：30 天死亡率增加 0.6 个百分点（调整比值比：1.17，95%CI 1.10 至 1.25），7 天死亡率增加 0.5 个百分点（调整比值比：1.23，95%CI 1.12 至 1.34），院内死亡率增加 0.5 个百分点（调整比值比：1.14，95%CI 1.08 至 1.21），与工作日白天入院相比。与工作日白天入院相比，周末夜间入院与 10 年中的 9 年的死亡率升高相关，但仅在 5 年中具有统计学意义（p<0.05）。
结论
急诊患者周末和夜间入院的死亡率均升高。这些影响是累加的，因此周末夜间入院的患者的死亡风险最大。这种增加的风险似乎随时间保持一致，但影响较小，且在每年的个别医院中不具有统计学意义。
Zotero 插件