Mortality and readmission differences associated with after-hours hospital admission: A population-based cohort study in Queensland Australia
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Boyle, Justin
Rolls, David
Khanna, Sankalp
Good, Norm
Xie, Yang
Romeo, Michele
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Abstract
Background and Aims Policy makers and health system managers are seeking evidence on the risks involved for patients associated with after-hours care. This study of approximately 1 million patients who were admitted to the 25 largest public hospitals in Queensland Australia sought to quantify mortality and readmission differences associated with after-hours hospital admission.
Methods Logistic regression was used to assess whether there were any differences in mortality and readmissions based on the time inpatients were admitted to hospital (after-hours versus within hours). Patient and staffing data, including the variation in physician and nursing staff numbers and seniority were included as explicit predictors within patient outcome models.
Results After adjusting for case-mix confounding, statistically significant higher mortality was observed for patients admitted on weekends via the hospital's emergency department compared to within hours. This finding of elevated mortality risk after-hours held true in sensitivity analyses which explored broader definitions of after-hours care: an “Extended” definition comprising a weekend extending into Friday night and early Monday morning; and a “Twilight” definition comprising weekends and weeknights.
There were no significant differences in 30-day readmissions for emergency or elective patients admitted after-hours. Increased mortality risks for elective patients was found to be an evening/weekend effect rather than a day-of-week effect. Workforce metrics that played a role in observed outcome differences within hours/after-hours were more a time of day rather than day of week effect, i.e. staffing impacts differ more between day and night than the weekday versus weekend.
Conclusion Patients admitted after-hours have significantly higher mortality than patients admitted within hours. This study confirms an association between mortality differences and the time patients were admitted to hospital, and identifies characteristics of patients and staffing that affect those outcomes.
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Health Science Reports
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6
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3
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© 2023 Commonwealth of Australia and The Authors. Health Science Reports published by Wiley Periodicals LLC.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Biomedical and clinical sciences
Health sciences
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Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Medicine, General & Internal
General & Internal Medicine
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Bell, A; Boyle, J; Rolls, D; Khanna, S; Good, N; Xie, Y; Romeo, M, Mortality and readmission differences associated with after-hours hospital admission: A population-based cohort study in Queensland Australia, Health Science Reports, 2023, 6 (3), pp. e1150