Weekend effect on mortality by medical specialty in six secondary hospitals in the Helsinki metropolitan area over a 14-year period
Weekend effect on mortality by medical specialty in six secondary hospitals in the Helsinki metropolitan area over a 14-year period
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DOI：
10.1186/s12913-020-05142-4
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发表时间：
2020-04-17
影响因子：
2.8
通讯作者：
Lehtonen, Lasse
中科院分区：
文献类型：
--
作者：
Tolvi, Morag;Mattila, Kimmo;Lehtonen, Lasse
研究背景周末效应是指患者入院当天影响其死亡风险的现象。我们的研究回顾了大赫尔辛基地区6家二级医院14年来的专科情况，以检查集中服务对周末效应的影响。方法从2000-2013年我院区28,591,840例就诊患者中，抽取仅在二级医院治疗的住院患者，这些患者在住院期间或出院后30天内死亡。我们根据每次入院的类型（即择期与急诊）以及临床服务提供者的专业和主要诊断对患者进行分类。结果共纳入456，676例住院患者（292，399例急诊住院患者），其中17，231例在住院或出院后30天内死亡。在7个专科中的1个，观察到急诊患者的住院和出院后30天死亡率具有统计学显著性的周末效应。对于择期患者，8个专科中有4个的住院死亡率和8个专科中有3个的出院后30天死亡率存在统计学显著的周末效应。外科、内科和妇产科最容易出现这种现象。结论：对于大多数专科的择期患者，存在周末效应，这表明需要制定这些入院指南。有必要进行更多针对特定疾病的研究，以找到受周末效应影响最大的诊断，并相应地调整人员配置。
Background The weekend effect is the phenomenon of a patient's day of admission affecting their risk for mortality. Our study reviews the situation at six secondary hospitals in the greater Helsinki area over a 14-year period by specialty, in order to examine the effect of centralization of services on the weekend effect. Methods Of the 28,591,840 patient visits from the years 2000-2013 in our hospital district, we extracted in-patients treated only in secondary hospitals who died during their hospital stay or within 30 days of discharge. We categorized patients based on the type of each admission, namely elective versus emergency, and according to the specialty of their clinical service provider and main diagnosis. Results A total of 456,676 in-patients (292,399 emergency in-patients) were included in the study, with 17,231 deaths in-hospital or within 30 days of discharge. A statistically significant weekend effect was observed for in-hospital and 30-day post-discharge mortality among emergency patients for 1 of 7 specialties. For elective patients, a statistically significant weekend effect was visible in in-hospital mortality for 4 of 8 specialties and in 30-day post-discharge mortality for 3 of 8 specialties. Surgery, internal medicine, and gynecology and obstetrics were most susceptible to this phenomenon. Conclusions A weekend effect was present for the majority of specialties for elective patients, indicating a need for guidelines for these admissions. More disease-specific research is necessary to find the diagnoses, which suffer most from the weekend effect and adjust staffing accordingly.