Does the 'Weekend Effect' exist in Elderly Internal Medicine Patients visiting the Emergency Department?
Brouns, S.H.A., Wachelder, J.J.H., Jonkers, F.S., Lambooij, S.L.E., Haak, H.R.
Voorzitter(s): dr. R. Heijligberg, Ede & dr. A.F. Mulder, Utrecht
Locatie(s): Zaal 0.2/0.3
Categorie(ën):
Introduction: Staffing levels and availability of diagnostic resources are reduced during weekends, which may compromise the quality of emergency care. This phenomenon, labeled as the “weekend effect”, has been identified as a risk factor of poor health outcome. Weekend delay could influence the Monday mortality rate, due to increased severity of illness of patients presenting to the ED on this day. Elderly patients are underrepresented in research on the “weekend effect”.
Aim of the study: To compare the in-hospital and 2-day mortality rate between ED patients aged 65 years and older admitted on weekends compared with weekdays. Assessment of the effect of admission on Monday was a secondary goal.
Material and methods: A retrospective cohort study of ED encounters of internal medicine patients ≥65 years presenting to Máxima Medical Centre between 1 September 2010 and 31 August 2011 was conducted. Data on demographic and clinical characteristics at ED presentation, ED diagnosis and treatment, and patient outcome were obtained from patient records. The weekend was defined as the period from midnight on Friday to midnight on Sunday.
Results: Data on 1784 ED visits by elderly internal medicine patients (mean age 77.5 years) were included. 1300 ED visits (72.9%) resulted in hospitalization, of which 267 admissions (20.5%) occurred on weekends. Comorbidity and urgency level were higher in patients admitted on weekends.
The in-hospital mortality rate was 11.2% for patients admitted on weekends compared with 10.3% on weekdays (p=0.654). Eight patients hospitalized on weekends (3.0%) died within 2 days of admission compared with 26 patients (2.5%) on weekdays (p=0.657). Admission on weekends was not associated with increased in-hospital or 2-day mortality rate (OR 1.1, 95%CI 0.7-1.7 and OR 0.9, 95%CI 0.4-2.1, respectively). In-hospital and 2-day mortality rate in elderly ED patients were similar among patients admitted on Monday or the rest of the week (respectively, OR 1.3 95%CI 0.8-2.2 and OR 1.0 95%CI 0.4-2.4).
Conclusion: The in-hospital and 2-day mortality rates were comparable among elderly patients hospitalized on weekends or on weekdays following an ED visit. Emergency care for the elderly is not compromised by the changed logistics during the weekend.