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 Even after adjusting for patient characteristics, including the
severity of the condition that brought them to the hospital, weekend
admission was still linked with more than a 20 percent increased
likelihood of hospital-acquired conditions when compared to weekday
admissions, lead author Dr. Frank Attenello, a researcher at the
University of Southern California, said by email.
Attenello and colleagues analyzed data from more than 350 million
admissions from 2002 to 2010 and found that 16.7 million of these
stays, or about 5 percent, resulted in at least one avoidable
hospital-acquired condition.
Falls were the most common complication, occurring in 14 million
admissions and accounting for 85 percent of all hospital-acquired
conditions. Pressure sores and catheter-associated urinary tract
infections were also common.
Even though most admissions - 81 percent - were on weekdays,
preventable complications were more common on weekends.
Hospital-acquired conditions occurred in 5.7 percent of weekend
admissions, compared to 3.7 percent in people admitted on weekdays.
"This increased hospital-acquired condition rate is significant
because we found presence of at least one hospital-acquired
condition to be associated with an 83 percent likelihood of
increased healthcare cost and a 38 percent increase in the
likelihood of a prolonged hospital stay," Attenello said.
The study has some limitations, including its reliance on insurance
billing codes, which don't always reflect all of the conditions
treated, the authors note. It also counted people admitted on
Sundays for elective surgery the following morning as weekend
admissions.
With billing codes, it's possible that the study underestimated the
number of catheter-associated urinary tract infections and
central-line associated bloodstream infections, said Dr. Kumar
Dharmarajan, a researcher at Yale University School of Medicine in
New Haven, Connecticut who wrote an editorial accompanying the study
in the British Medical Journal.
At the same time, conditions such as pressure sores might be
overestimated if they were present at the time of admission.
And, because the study doesn't note which day of the week patients
experienced a preventable illness or injury, it's difficult to say
how conditions on the weekends might contribute to problems,
Dharmarajan told Reuters Health in an email.
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"It is premature to conclude that factors intrinsic to the hospital
on weekends like reduced staffing or the increased number of
covering providers are primarily responsible for the greater number
of hospital-acquired conditions among weekend admissions,"
Dharmarajan said. "It is not clear that the weekend is a less safe
time for patients."
It's also possible that the study found more complications on
weekends because patients admitted then are sicker and in need of
more urgent treatment, said Sarah Krein, a researcher at the Ann
Arbor VA Center for Clinical Management Research at the University
of Michigan.
"It isn't clear whether more aggressive prevention efforts are
needed on weekends or whether patients admitted on weekends should
be viewed as high-risk for hospital-acquired complications thus
warranting extra vigilance throughout the course of their hospital
stay," Krein, who wasn't involved in the study, said by email.
Still, the study highlights the need for better prevention,
including efforts to avoid the most common complications, such as
falls and infections, as well as initiatives at the administrative
level that can improve staffing or organizational factors
contributing to complications, said Enrique Castro-Sanchez, a
researcher at the Center for Infection Prevention and Management at
Imperial College, London.
"In light of the enormous number of patient discharges analyzed by
the authors in the study period, any reduction in the rate of
preventable healthcare conditions is likely to improve the
experience of care of millions of patients," Castro-Sanchez, who
wasn't involved in the study, said by email.
SOURCE: http://bmj.co/1PcIpgN
http://bmj.co/1PcIeCh BMJ,
online April 15, 2015.
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