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December 2001
Vol. 4, No. 12, pp 12.
news in brief
Avoid hospitals on weekends?
Good timing may be more important than previously thought when going to the hospital for a serious condition, according to a study conducted by Chaim Bell and Donald Redelmeier of the University of Toronto (N. Engl. J. Med. 2001, 345, 663-668). The research indicates that more people die from serious illnesses if they are admitted to the hospital on the weekend than if they are admitted during the week.

The researchers examined records from all acute-care hospital admissions in Ontario, Canada, between April 1, 1988, and March 31, 1997, paying particular attention to three prespecified conditions: ruptured abdominal aortic aneurysm, acute epiglottitis, and pulmonary embolism, which, the researchers indicated, were conditions likely to be affected by a shortage of staff and inadequate supervision. For the total number of admissions (3,789,917), the mortality rate was slightly higher for those admitted on the weekend (1.8%) than for those admitted during the week (1.6%), but for the three specified conditions, the differences were more significant. The mortality rate increased from 36% for weekday admissions to 42% for weekend admissions for ruptured abdominal aortic aneurysms, from 0.3% to 1.7% for acute epiglottitis, and from 11% to 13% for pulmonary embolism.

The researchers also looked at the admissions for the 100 conditions (excluding motor vehicle and gun injuries) that resulted in the highest numbers of hospital deaths during the same period. Of these conditions, 26 showed a significantly greater mortality percentage among weekend admittees.

One hypothesis to explain these statistics is that the lack of staff and the less experienced staff that are common in hospitals during weekends result in more deaths during the weekend. Even though the physicians did take into account age, sex, and a morbidity index for each patient, the research does not definitively show that patients admitted on the weekend were not simply, on average, sicker. But these results seem to provide a good basis for quantifying a serious problem that may exist in the health care community in Canada, and pointing to issues in the United States, where hospital staffing levels are also less than ideal.

MICHAEL J. FELTON

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