Interdisciplinary Centre for Organizational Architecture, Department of Management, Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, build. 2610-336, 8210, Aarhus V, Denmark.
DESIGN EM - Research Network for Organizational Design and Emergency Medicine, Fuglesangs Allé 4, build. 2610, 8210, Aarhus V, Denmark.
Scand J Trauma Resusc Emerg Med. 2018 Sep 5;26(1):72. doi: 10.1186/s13049-018-0542-x.
Despite extensive research on the "weekend effect" i.e., the increased mortality associated with hospital admission during weekend, knowledge about disease severity in previous studies is limited. The aim of this study is to examine patient characteristics, including disease severity, 30-day mortality, and length of stay (LOS), according to time of admission to an emergency department.
Our study encompassed all patients admitted to a Danish emergency department in 2014-2015. Using data from electronic patient records, this study examines patient characteristics including age, gender, Charlson Comorbidity Index score, triage score, and primary diagnosis. Triage score and transfer to intensive care unit (ICU) were used as indicators of disease severity. LOS within the department and within the hospital was examined. Age- and sex-standardized 30-day mortality rates comparing patients with the same triage score admitted at daytime, evening, and nighttime on weekdays and on weekends were computed. To test differences, a Cox regression analysis was added.
We included 35,459 patient visits, of which 10,435 (32%) started on a weekend. There were no large differences in baseline characteristics between patients admitted on weekdays and those admitted on weekends. The relative risk (RR) for being triaged orange or red was 1.16 (95% confidence interval (CI) 1.06-1.28, P = 0.0017) for weekend admissions as compared with weekday admissions. Weekend admissions were twice as likely as weekday admissions to be transferred to the ICU (RR, 1.96; 95% CI 1.53-2.52, P = 0.0000). No significant changes were found in LOS. The 30-day mortality rate increased with disease severity regardless of time of admission. When comparing the 30-day mortality rate for patients with the same triage score, the trend was toward a higher mortality when admission occurred during the weekend. Increasing mortality rate was significant for patients admitted at evening on weekends with a hazard ratio of 1.32 (95% CI 1.03-1.70, P = 0.027) when compared with patients admitted on daytime on weekdays.
When comparing weekday and weekend admissions, the 30-day mortality rate increased for patients admitted at evening on weekends after adjusting for comorbidity and triage score, indicating that the weekend effect was independent of changes in illness severity.
尽管已经对“周末效应”（即周末住院相关的死亡率增加）进行了广泛的研究，但关于之前研究中疾病严重程度的知识有限。本研究旨在根据急诊就诊时间，检查患者特征，包括疾病严重程度、30 天死亡率和住院时间（LOS）。
我们的研究包括 2014-2015 年丹麦急诊就诊的所有患者。使用电子病历数据，本研究检查了患者特征，包括年龄、性别、Charlson 合并症指数评分、分诊评分和主要诊断。分诊评分和转入重症监护病房（ICU）作为疾病严重程度的指标。检查了部门内和医院内的 LOS。计算了年龄和性别标准化的 30 天死亡率，比较了白天、晚上和周末在同一分诊评分下入院的患者。为了检验差异，添加了 Cox 回归分析。
我们纳入了 35459 次就诊，其中 10435 次（32%）在周末开始。在白天和周末入院的患者之间，基线特征没有明显差异。与白天就诊相比，周末就诊的橙色或红色分诊的相对风险（RR）为 1.16（95%置信区间（CI）1.06-1.28，P=0.0017）。周末就诊患者转入 ICU 的可能性是白天就诊患者的两倍（RR，1.96；95%CI 1.53-2.52，P=0.0000）。LOS 无显著变化。无论就诊时间如何，疾病严重程度的 30 天死亡率均增加。当比较相同分诊评分的患者 30 天死亡率时，周末就诊的死亡率呈上升趋势。与白天工作日就诊的患者相比，周末晚上就诊的患者死亡率更高，危险比为 1.32（95%CI 1.03-1.70，P=0.027）。
与白天工作日就诊相比，调整合并症和分诊评分后，周末晚上就诊的患者 30 天死亡率增加，表明周末效应独立于疾病严重程度的变化。
