Weekend Hospital Admission and Discharge for Heart Failure
Weekend Hospital Admission and Discharge for Heart Failure
Background: Although hospital admissions during weekends have been associated with worse quality of care and worse outcomes in some but not all medical conditions, the impact of weekend versus weekday admission and discharge for heart failure (HF) has not been well studied. This study investigates the association of (1) weekend compared to weekday HF admissions and discharges with quality of care and (2) weekend versus weekday HF admissions with length of stay (LOS) and mortality in the hospital.
Methods: Data were analyzed for 81,810 HF admissions at 241 sites participating in Get With the Guidelines (GWTG)–HF from January 2005 to September 2008. The cohort was stratified by weekend versus weekday admission and discharge. Generalized estimating equations adjusted for patient and hospital characteristics and clustering.
Results: Mean age was 72 ± 14 years; left ventricular ejection fraction (LVEF) was 39 ±17%. Inhospital mortality was 3.0% and median LOS 4 days. Weekend admission was associated with decreased odds of LVEF documentation. Weekend discharge was associated with decreased odds of LVEF documentation and completed discharge instructions. Weekend HF admission compared to weekday admission was associated with slightly higher risk-adjusted odds of longer inhospital LOS (1.03 [1.01–1.05] and increased inhospital mortality (1.13 [1.02–1.27]).
Conclusions: Among GWTG-HF hospitals, weekend admission and discharge for HF were associated with similar quality of care in many but not all measures. Risk-adjusted LOS was slightly longer and mortality moderately higher for weekend HF admissions.
Admission to the hospital during weekends is associated with increased mortality in some but not all acute medical conditions. Acute myocardial infarction, stroke, pulmonary embolism, ruptured abdominal aortic aneurysm, and intensive care unit admissions have all been associated with increased inhospital or short-term mortality during weekends compared to weekdays. Reduced staffing and physician coverage, decreased use of invasive medical therapies, and differences in patient characteristics may in part explain the discrepancy in outcomes between weekend and weekday hospital admissions. Discharge timing has been less well studied than admission timing; however, discharges from the hospital during weekends may also be affected by reduced staffing and physician coverage. Hospital discharges may be delayed over the weekend or result in higher postdischarge mortality.
The impact of weekend vs weekday timing of admission and discharge for heart failure (HF) has not been well studied. One recent investigation of 48,612 HF hospital admissions tracked in a national registry found that day of week did not influence inpatient or short-term postdischarge mortality. However, length of stay (LOS) was significantly affected by admission day, with Thursday and Friday admissions associated with the longest LOS. The effect of weekend admission or discharge for HF on quality of care has not been previously studied. Because quality of care during HF admissions may be associated with clinical outcomes, we sought to investigate the relationship between weekend HF admission and quality of care, hospital LOS, and inhospital mortality. We also sought to investigate the impact of weekend discharge for HF on quality of care measures.
Abstract and Introduction
Abstract
Background: Although hospital admissions during weekends have been associated with worse quality of care and worse outcomes in some but not all medical conditions, the impact of weekend versus weekday admission and discharge for heart failure (HF) has not been well studied. This study investigates the association of (1) weekend compared to weekday HF admissions and discharges with quality of care and (2) weekend versus weekday HF admissions with length of stay (LOS) and mortality in the hospital.
Methods: Data were analyzed for 81,810 HF admissions at 241 sites participating in Get With the Guidelines (GWTG)–HF from January 2005 to September 2008. The cohort was stratified by weekend versus weekday admission and discharge. Generalized estimating equations adjusted for patient and hospital characteristics and clustering.
Results: Mean age was 72 ± 14 years; left ventricular ejection fraction (LVEF) was 39 ±17%. Inhospital mortality was 3.0% and median LOS 4 days. Weekend admission was associated with decreased odds of LVEF documentation. Weekend discharge was associated with decreased odds of LVEF documentation and completed discharge instructions. Weekend HF admission compared to weekday admission was associated with slightly higher risk-adjusted odds of longer inhospital LOS (1.03 [1.01–1.05] and increased inhospital mortality (1.13 [1.02–1.27]).
Conclusions: Among GWTG-HF hospitals, weekend admission and discharge for HF were associated with similar quality of care in many but not all measures. Risk-adjusted LOS was slightly longer and mortality moderately higher for weekend HF admissions.
Introduction
Admission to the hospital during weekends is associated with increased mortality in some but not all acute medical conditions. Acute myocardial infarction, stroke, pulmonary embolism, ruptured abdominal aortic aneurysm, and intensive care unit admissions have all been associated with increased inhospital or short-term mortality during weekends compared to weekdays. Reduced staffing and physician coverage, decreased use of invasive medical therapies, and differences in patient characteristics may in part explain the discrepancy in outcomes between weekend and weekday hospital admissions. Discharge timing has been less well studied than admission timing; however, discharges from the hospital during weekends may also be affected by reduced staffing and physician coverage. Hospital discharges may be delayed over the weekend or result in higher postdischarge mortality.
The impact of weekend vs weekday timing of admission and discharge for heart failure (HF) has not been well studied. One recent investigation of 48,612 HF hospital admissions tracked in a national registry found that day of week did not influence inpatient or short-term postdischarge mortality. However, length of stay (LOS) was significantly affected by admission day, with Thursday and Friday admissions associated with the longest LOS. The effect of weekend admission or discharge for HF on quality of care has not been previously studied. Because quality of care during HF admissions may be associated with clinical outcomes, we sought to investigate the relationship between weekend HF admission and quality of care, hospital LOS, and inhospital mortality. We also sought to investigate the impact of weekend discharge for HF on quality of care measures.
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