Intended for healthcare professionals


Patients need safer hospitals, every day of the week

BMJ 2015; 350 doi: (Published 15 April 2015) Cite this as: BMJ 2015;350:h1826
  1. Kumar Dharmarajan, assistant professor of medicine1,
  2. Nancy Kim, assistant professor of medicine2,
  3. Harlan M Krumholz, professor of medicine1
  1. 1Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
  2. 2Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
  1. Correspondence to: K Dharmarajan kumar.dharmarajan{at}

Hospital acquired conditions must be reduced throughout the week, not just at weekends

In the United States, efforts to improve patient safety have focused, in part, on reducing hospital acquired conditions, or HACs. Hospital acquired conditions include healthcare associated infections, iatrogenic complications, and other adverse events occurring during treatment for another condition. Historically, the additional costs incurred by these adverse events led to greater payments by the government.1 To encourage a reduction in these potentially preventable conditions, the US Centers for Medicare and Medicaid Services (CMS) in 2008 decided not to pay for the higher costs of care resulting from 14 specific hospital acquired conditions.2 Starting this year, the CMS’s HAC Reduction Program will levy considerable financial penalties on hospitals scoring poorly on a composite measure of performance regarding hospital acquired conditions, which is derived from a review of administrative claims and medical record data.3 4

In a linked paper, Attenello and colleagues (doi:10.1136/bmj.h1460) determined whether weekend admission is associated with a greater likelihood of developing these adverse events,5 as weekend admission has been associated with worse outcomes for a large number of life threatening conditions, such as myocardial infarction,6 pulmonary embolism,7 and intracerebral haemorrhage.8 …

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