weissman J, Bendavid E, Kaganova Y, Needleman J, Gruenberg L, Weissman JS; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4168.
MGH/Harvard, Inst. Health Policy, 50 Staniford St, Boston, MA 02114 Tel. 617-724-4731 Fax 617-724-4738
RESEARCH OBJECTIVE: Recent studies suggest that patient safety is compromised on weekends. A limitation of previous studies that examined mortality of patients admitted on weekends is that it is difficult to attribute the outcome to preceding care delivered on a particular date. We sought to determine whether rates of complications in hospitals are higher on weekends than on weekdays using large state administrative databases and AHRQs Patient Safety Indicators. STUDY DESIGN: We analyzed complications using Patient Safety Indicators (PSIs) developed by AHRQ. Of the 20 PSIs, and , after consultation with staff physicians and senior coders, we selected eight that could be assigned to a particular day: complications of anesthesia, retained foreign bodies, post-operative hemorrhage, accidental cuts and lacerations during procedures, birth trauma, obstetric trauma during vaginal deliveries with and without instrumentation, and obstetric trauma during Cesarean delivery. For example, for the complication retained foreign bodies, the complication was assigned to the date of the first major surgery the patient underwent. Odds ratios comparing weekends versus weekdays were estimated with adjustment for age, sex, comorbidities, and route and type of admission. Hospital clustering was taken into account. In two subgroup analyses we restricted the population to patients who underwent cardiac or vascular procedures and combined the four surgical complications into one group. POPULATION STUDIED: 4,967,114 admissions to acute care hospitals in three states (Massachusetts, New York, North Carolina) from 1999-2001. The data were obtained from the Healthcare Utilization Projects (HCUP) State Inpatient Databases. We chose the three states for their geographic variability and the availability of procedure dates needed for identification of weekend and weekday complications. PRINCIPAL FINDINGS: Weekend admissions constituted 14.8% of the total number of admissions. Four out of eight complications occurred more frequently on weekends: post-operative hemorrhage (OR 1.07, p<0.05), newborn trauma (OR 1.06, p<0.05), vaginal deliveries without instrumentation (OR 1.03, p<0.05), and obstetric trauma during C-sections (OR 1.36, p<0.01). Complications of anesthesia occurred less frequently on weekends compared to weekdays (54 vs. 63 per 100,000 admissions, OR 0.86, p<0.05). Among patients undergoing vascular procedures, surgical complications occurred more frequently on weekends (OR 1.46, p<0.01). CONCLUSIONS: There is increasing evidence that weekend hospitalizations put patients at increased risk compared with weekdays, and this study emphasizes some of the areas where patient safety may be compromised. Rates of complications were greater on weekends than on weekdays for selected complications including obstetric trauma and surgical complications for patients undergoing vascular procedures. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Hospitals should work towards minimizing patient safety hazards and increasing the robustness of safeguards on weekends.
Publication Types:
Keywords:
- Comorbidity
- Delivery, Obstetric
- Disease Progression
- Female
- Foreign Bodies
- Hospitalization
- Hospitals
- Humans
- Infant, Newborn
- Inpatients
- Massachusetts
- New York
- North Carolina
- Obstetric Labor Complications
- Pregnancy
- Safety
- Time
- United States Agency for Healthcare Research and Quality
- complications
- injuries
- surgery
- hsrmtgs
UI: 103623631
From Meeting Abstracts