Williams Ryan, Farquharson Lorna, Rhodes Ellen, Dang Mary, Lindsay Natasha, Quirk Alan, Baldwin David S, Crawford Mike J
Department of Brain Sciences, Imperial College London; and College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Department of Clinical Psychology, University of East London; and College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
BJPsych Open. 2020 Sep 3;6(5):e103. doi: 10.1192/bjo.2020.88.
Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the 'working week'.
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39-0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46-0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30-0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50-0.97).
There is no evidence of a 'weekend effect' for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
关于患者在周末入住或出院时所接受的护理标准差异的问题已经出现。
比较焦虑和抑郁障碍患者在周末入住或出院与在“工作日”入住或出院时所接受的护理质量。
对英格兰3795例入住精神病住院病房的病例进行回顾性病例记录审查。使用多变量回归分析比较抑郁或焦虑障碍患者所接受的护理质量。
总共795例（20.9%）患者在周末入院，157例（4.8%）在周末出院。周末入院患者与工作日入院患者的护理质量差异极小。周末出院的患者在出院前不太可能得到充分通知（48小时）（比值比=0.55，95%置信区间0.39 - 0.78），不太可能有危机预案（比值比=0.65，95%置信区间0.46 - 0.92），也不太可能得到带回家服用的药物（比值比=0.45，95%置信区间0.30 - 0.66）。他们也不太可能使用经过验证的结果测量方法进行评估（比值比=0.70，95%置信区间0.50 - 0.97）。
没有证据表明周末入住精神病院的患者存在“周末效应”，但周末出院患者所接受的护理质量相对较差，这凸显了在这一领域进行改进的必要性。
