Study Finds Patients Admitted to Hospitals on Weekends are at Greater Risk for “Never Events”

Falls and infections are more common among patients admitted to hospitals on weekends, according to a new study conducted by researchers at the University of Southern California and published in the British Medical Journal. The research team analyzed data from more than 350 million hospital admissions from 2002 to 2010. Even though the vast majority (81 percent) of the admissions were on weekdays, there were more complications in patients admitted on weekends (5.7 percent of complications compared with 3.7 percent for patients admitted on week days). The most common kinds of hospital-acquired infections among patients admitted on weekends were pressure ulcers and catheter-associated urinary tract infections.

The research team could not determine whether the higher proportion of complications were due to lower staffing rates on weekends or patients with more urgent treatment needs being admitted during those times.

These findings are consistent with a body of research showing that patients admitted during off-peak hours (like evenings and weekends) experienced more health problems, and were less likely to survive in-hospital cardiac arrest, and that newborns born on weekends were more likely to die than babies born during the week.

An INQRI-funded study led by Patti Hamilton and Gretchen Gemeinhardt found that nurses’ “off-peak” work environments play a significant role in the increased patient mortality during these time periods.  In particular, the researchers found that nurses who participate in hospital plans that allow them to work only weekend shifts for full pay and benefits are less familiar with their institutions’ initiatives and priorities that govern policies, procedures, principles and regulations for providing care, because those initiatives and priorities are stressed more during peak periods.

Staffing Issues a Factor in Higher Weekend Hospitalization Mortality Rates

Patients hospitalized on weekends are at a 15 percent higher risk of dying due to issues related to nurse and physician staffing and training, according to a new report. Researchers concluded that “low staffing levels of nurses and physicians significantly impact mortality.” Mortality rates were also higher among patients admitted to the hospital on weekends in hospitals with less experienced staff, such as resident trainees.

The study, which is currently available in provisional form, was conducted by researchers from Tufts Medical Center in Boston who examined data on more than 48 million patients admitted to hospitals for non-elective reasons from January 1, 2003-December 31, 2008.

Researchers found that the overall odds of mortality were higher for patients in hospitals with fewer nurses and staff physicians. Hospitals with more nurses or physicians per hospital bed had a 10 percent lower rate of mortality after a weekend admission. Mortality in hospitals with the highest number of resident trainees was 17 percent higher following a weekend admission, compared with hospitals with no resident trainees.

An INQRI study, “The Effect of Off-peak Hospital Environments on Nurses' Work: an Institutional Ethnography” also revealed the negative impact of weekend and evening admissions on mortality rates. The INQRI study showed that nurses’ “off-peak” work environments play a significant role in the increased patient mortality.

In off-peak environments, nurses have less access to support, work with less supervision, and have strained communication with on-call health care providers, the study found. Researchers identified ways in which nurse administrators can mitigate the possible reasons for these disparities:

• Being conscious of the fact that the majority of hours nurses work are “off-peak” and ensuring that institutions’ efforts and programs include peak and “off-peak” times;
• Knowing that implementing a solution for a problem that occurs during peak hours may unintentionally create a problem for those nurses who work “off-peak” and involving nurses from every shift in planning and evaluating work processes;
• Collecting performance data in a way that allows for comparing that data across days of the week and times (both peak and “off-peak”), rather than aggregating data over 24 hours or over an entire week; and
• Proactively addressing nurse-physician relations in the hospital.

The INQRI grantees were Patti Hamilton and Gretchen Gemeinhardt.

Timing of Hospital Admissions Affects Outcomes for Heart Failure Patients

Research results presented at the annual meeting of the Heart Failure Association of the European Society of Cardiology show that heart failure patients who are admitted to hospitals in January, on Fridays and overnight have the highest death rates and longest hospital stays. Those admitted between 6am and noon had better outcomes than patients admitted in the evening, right before the weekend or in the middle of the night.

The study, which examined 14 years of data on more than 900,000 heart failure patients at New York hospitals, suggests that staffing plays a key role in outcomes, according to David Kao of the University of Colorado School of Medicine, who led the research team.

An INQRI-funded study led by Patti Hamilton and Gretchen Gemeinhardt revealed that patients admitted to hospitals during evenings and weekends ("off-peak" hours) experience more health problems. Nurses who work off-peak hours report that communication with other health providers is more difficult during those hours than during peak hours, which contributes to the poorer patient outcomes.

Another INQRI study, led by Robin Newhouse and Laura Morlock, and recently published in Medical Care, found that rural hospitals with lower nurse turnover and better practice environments were better able to implement a quality collaborative intervention aimed at improving care for heart failure patients.