The impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital

Lu Han, Matt Sutton, Stuart Clough, Richard Warner, Timothy Doran

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Emergency hospital admission at weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day – not time – of admission. We used an enhanced longitudinal dataset to estimate the ‘weekend effect’ over time and the effect of night-time admission on the mortality rate.

We examined 246,350 emergency spells from a large teaching hospital in England between April 2004 and March 2014. Outcomes included 7-day, 30-day and in-hospital mortality rates. We conducted probit regressions to estimate the impact of two key predictors on mortality: i) admission at weekends (7.00 pm Friday to 6.59 am Monday); ii) night-time admission (7.00 pm to 6.59 am). Logistic regressions were estimated to produce odds ratios.

Crude 30-day mortality rate decreased from 6.6% in 2004/05 to 5.2% in 2013/14. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission at weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.168), 7-day mortality by 0.4 percentage points (adjusted OR: 1.225), and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.140) compared with admission on weekday day-times. Weekend night-time admission was associated with increased mortality risk in 9 out of 10 years, but this was only statistically significant (P≤ 0.05) in 5 out of 10 years.

There is an increased risk of mortality for patients admitted as emergencies both at weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night at weekends. This increased risk appears to be consistent over time, but the effects are small and are not statistically significant in individual hospitals in every year.
Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalBMJ Quality & Safety
Early online date29 Sept 2017
Publication statusE-pub ahead of print - 29 Sept 2017

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© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017.

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