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Weekend hospitalization associated with 15 percent higher mortality rate

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Being hospitalized on the weekend could mean a greater risk of dying in the hospital, according to a new report from researchers at Tufts Medical Center in Boston. This paper, coming soon from BMC Medical Education and available online in provisional form now, indicates that individuals admitted to a hospital on a Saturday or a Sunday have a 15 percent greater chance of dying in the hospital than those admitted on a weekeday. The researchers attempt to identify the causes of this greater danger, and conclude that "low staffing levels of nurses and physicians significantly impact mortality" and that inpatients in hospitals with less experienced staff ("more resident trainees") had "significantly higher mortality following a weekend admission."

The researchers examined data from more than 48 million patients admitted to hospitals for non-elective reasons from January 1, 2003, through December 31, 2008. The source of this data is the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ). The researchers looked at two outcomes only: dying during hospitalization, and not dying during hospitalization. (Patients who died after being discharged did not have this outcome included in the study.)

Unfortunately, this is not the first time this problem has been identified. Journal articles going back for decades indicate a lower level of care on weekends, resulting in greater mortality, more complications, and longer hospital stays. A recent editorial in the British Medical Journal cites multiple studies demonstrating the deadly "weekend effect" and calls for changes in order to save lives. "The evidence seems sufficient to justify a change in how we deliver care at weekends," the authors contend.

The Tufts researchers agree: "Our data indicate that the role of staffing and resident trainees is an important area of focus for patient safety [...] Our data suggest that the role of resident supervision may be an important target for quality weekend medical care." They suggest the following steps: "An assessment of rounding practices, trainee-directed procedures, and / or call routines of supervising physicians would help answer questions raised by our study. Following these assessments, strategies can be developed and implemented to standardize care across admission day."

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