By Will Boggs MD
NEW YORK (Reuters Health) Jul 29 - Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are more likely to die in the hospital if they come in on a weekend, a study from Spain suggests.
"We think that the admission day outcome differences implicate a common structural or process measure," researcher Dr. Raquel Barba told Reuters Health by email. "Another possible cause of increased weekend mortality rate is low staffing levels during weekends."
"The shortfall of weekend medical care is important because the consequences of adverse events cannot always be offset by working harder on subsequent days," she said.
Many authors have looked at the impact of weekend admission, with widely divergent results.
In a recent UK study, mortality was no worse among patients who presented on weekends with upper gastrointestinal bleeding. But another study, by U.S. researchers, showed 10% higher hospital mortality for patients admitted on weekends. Patients admitted with myocardial infarction to cardiac centers have similar survival rates whether they arrive on weekdays or weekends, whereas patients treated by trauma teams may actually fare better when admitted on weekends vs weekdays. (See Reuters Health stories published this year on March 22, March 23, May 20 and June 7.)
Most recently, on June 9th in an online paper in the European Respiratory Journal, Dr. Barba from Hospital Infanta Cristina, Parla, Madrid and colleagues reported mortality rates in 69,770 patients admitted for COPD exacerbations on weekends and another 219,307 similar patients admitted on weekdays, all at hospitals in Spain.
Roughly one in eight patients (12.4%) died in the hospital - a quarter of them (8924, 25.1%) in the first 48 hours.
Case fatality rates were significantly higher on weekends than on weekdays (12.9% vs 12.1%), and this finding held true even after adjustment for demographic characteristics and comorbidities.
When the analysis was limited to deaths within two days after admission, patients admitted on weekends had a 16% increase in early mortality compared to patients admitted on weekdays.
When deaths within 24 hours of admission were analyzed, the risk was 39% higher for patients admitted on the weekend.
Dr. Barba says a more a consistent level of activity on weekends might be economical - but it wouldn't be popular.
She adds, "Quality improvement strategies can be developed and implemented to standardize care across admission day: electronic automated alarms designed to detect patients at higher risk or to ensure physicians apply specific protocols for special patients could help in this task. Health information technology, such as electronic medical records, computerized provider order entry system and clinical decision support systems, have been touted to improve patient safety and quality of care."
Dr. Barba and her team are conducting a two-year study involving all acute care hospitals in Spain, to compare mortality in heart failure patients admitted on weekends vs weekdays.
They want to find out, she said, "whether the quality of hospital care can be improved by policies that increase patient's safety and quality of care."
Eur Respir J 2011.
اللَّهُمَّ نَجِّ الْمُسْتَضْعَفِينَ مِنَ الْمُؤْمِنِينَ اللَّهُمَّ اشْدُدْ وَطْأَتَكَ عَلَى مُضَرَ اللَّهُمَّ اجْعَلْهَا عَلَيْهِمْ سِنِينَ كَسِنِي يُوسُفَ