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Incidence of “never events” among weekend admissions versus weekday admissions to US hospitals: national analysis

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1460 (Published 15 April 2015) Cite this as: BMJ 2015;350:h1460
  1. Frank J Attenello, clinical instructor of neurosurgery1,
  2. Timothy Wen, research associate2,
  3. Steven Y Cen, assistant professor of research neurology 34,
  4. Alvin Ng, research associate5,
  5. May Kim-Tenser, assistant professor of neurology3,
  6. Nerses Sanossian, assistant professor of neurology3,
  7. Arun P Amar, associate professor of neurosurgery1,
  8. William J Mack, associate professor of neurosurgery1
  1. 1Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
  2. 2Keck School of Medicine, University of Southern California, USA
  3. 3Department of Neurology, Keck School of Medicine, University of Southern California, USA
  4. 4Department of Radiology, Keck School of Medicine, University of Southern California, USA
  5. 5Department of Preventive Medicine, Keck School of Medicine, University of Southern California, USA
  1. Correspondence to: T Wen wentimot{at}usc.edu
  • Accepted 17 February 2015

Abstract

Objective To evaluate the association between weekend admission to hospital and 11 hospital acquired conditions recently considered by the Centers for Medicare and Medicaid as “never events” for which resulting healthcare costs are not reimbursed.

Design National analysis.

Setting US Nationwide Inpatient Sample discharge database.

Participants 351 million patients discharged from US hospitals, 2002-10.

Main outcome measures Univariate rates and multivariable likelihood of hospital acquired conditions among patients admitted on weekdays versus weekends, as well as the impacts of these events on prolonged length of stay and total inpatient charges.

Results From 2002 to 2010, 351 170 803 patients were admitted to hospital, with 19% admitted on a weekend. Hospital acquired conditions occurred at an overall frequency of 4.1% (5.7% among weekend admissions versus 3.7% among weekday admissions). Adjusting for patient and hospital cofactors the probability of having one or more hospital acquired conditions was more than 20% higher in weekend admissions compared with weekday admissions (odds ratio 1.25, 95% confidence interval 1.24 to 1.26, P<0.01). Hospital acquired conditions have a negative impact on both hospital charges and length of stay. At least one hospital acquired condition was associated with an 83% (1.83, 1.77 to 1.90, P<0.01) likelihood of increased charges and 38% likelihood of prolonged length of stay (1.38, 1.36 to 1.41, P<0.01).

Conclusion Weekend admission to hospital is associated with an increased likelihood of hospital acquired condition, cost, and length of stay. Future protocols and staffing regulations must be tailored to the requirements of this high risk subgroup.

Footnotes

  • Contributors: FJA, TW, and SYC provided substantial contributions to the conception and design of the study, data acquisition, interpretation of data, drafting of the manuscript, and final approval of the version to be published, and is in agreement to be accountable for all aspects of the work. AN provided substantial contributions to the conception and design of the study, data acquisition and analysis, interpretation of the data, and drafting of the manuscript, and is in agreement to be accountable for all aspects of the work. MK-T, NS, APA, and WJM provided substantial contributions to the conception and design of the study, interpretation of the data, drafting of the manuscript, and final approval of the version to be published, and is in agreement to be accountable for all aspects of the work. FJA and WJM are the guarantors.

  • Funding: This study received no specific funding.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • Transparency: The lead author (FJA) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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