Exploratory study of the 'weekend effect' for acute medical admissions to public hospitals in Queensland, Australia

Clarke, M. S., Wills, R.-A., Bowman, R. V., Zimmerman, P. V., Fong, K. M., Coory, M. D. and Yang, I. A. (2010) Exploratory study of the 'weekend effect' for acute medical admissions to public hospitals in Queensland, Australia. Internal Medicine Journal, 40 11: 777-783. doi:10.1111/j.1445-5994.2009.02067.x

Author Clarke, M. S.
Wills, R.-A.
Bowman, R. V.
Zimmerman, P. V.
Fong, K. M.
Coory, M. D.
Yang, I. A.
Title Exploratory study of the 'weekend effect' for acute medical admissions to public hospitals in Queensland, Australia
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
Publication date 2010-11-01
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1445-5994.2009.02067.x
Volume 40
Issue 11
Start page 777
End page 783
Total pages 7
Place of publication Richmond, Vic., Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Formatted abstract
Aims: To determine whether in-hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the 'weekend effect').
Methods: We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003-2006/2007 financial years. The primary outcome was 30-day in-hospital mortality. The secondary outcome of 2-day in-hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care.
Results: During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30-day in-hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81-1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86-1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54-1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03-1.26, P= 0.007). Two-day in-hospital mortality showed similar results.
Conclusion: This is the first Australian study on the 'weekend effect' (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia.
© 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.
Keyword COPD
Myocardial infarction
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 7 OCT 2009

Document type: Journal Article
Sub-type: Article (original research)
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