Early In-Hospital Mortality following Trainee Doctors' First Day at Work
Early In-Hospital Mortality following Trainee Doctors' First Day at Work
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DOI：
10.1371/journal.pone.0007103
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发表时间：
2009-09-23
期刊：
影响因子：
3.7
通讯作者：
Aylin, Paul
中科院分区：
文献类型：
--
作者：
Jen, Min Hua;Bottle, Alex;Aylin, Paul
背景：人们普遍认为八月初是英国入院的不安全时期，因为新获得资格的医生会在八月的第一个星期三开始在 NHS 医院工作。我们调查八月第一个星期三之后一周的院内死亡率是否高于前一周。方法：在英格兰进行的一项回顾性研究，使用行政入院数据。对 2000 年至 2008 年 7 月最后一个星期三和 8 月第一个星期三入院的所有急诊患者进行两个回顾性队列，每个队列随访一周。 主要发现：在控制年份、性别、年龄、社会经济剥夺后，8 月第一个星期三入院患者的死亡几率高出 6%（OR 1.06，95% CI 1.00 至 1.15，p = 0.05）和合并症。当细分为内科、外科和肿瘤入院时，8 月第一个星期三入院的死亡几率高出 8%（OR 1.08，95% CI 1.01 至 1.16，p = 0.03）。 2007年和2008年，当初级医生职位申请制度发生变化时，8月1日星期三入院的患者的调整后死亡几率比上周三入院的患者高8%，但这并不具有统计学意义（OR 1.08，95% CI 0.95至1.23，p = 0.24）。 结论：我们发现证据表明，与英国医院相比，8月第一个星期三入院的患者早期死亡率更高与上周三入院的患者一起。对于经医学初步诊断入院的患者来说，这一比例更高。
Background: There is a commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August. We investigate whether in-hospital mortality is higher in the week following the first Wednesday in August than in the previous week.Methodology: A retrospective study in England using administrative hospital admissions data. Two retrospective cohorts of all emergency patients admitted on the last Wednesday in July and the first Wednesday in August for 2000 to 2008, each followed up for one week.Principal Findings: The odds of death for patients admitted on the first Wednesday in August was 6% higher (OR 1.06, 95% CI 1.00 to 1.15, p = 0.05) after controlling for year, gender, age, socio-economic deprivation and co-morbidity. When subdivided into medical, surgical and neoplasm admissions, medical admissions admitted on the first Wednesday in August had an 8% (OR 1.08, 95% CI 1.01 to 1.16, p = 0.03) higher odds of death. In 2007 and 2008, when the system for junior doctors' job applications changed, patients admitted on Wednesday August 1(st) had 8% higher adjusted odds of death than those admitted the previous Wednesday, but this was not statistically significant (OR 1.08, 95% CI 0.95 to 1.23, p = 0.24).Conclusions: We found evidence that patients admitted on the first Wednesday in August have a higher early death rate in English hospitals compared with patients admitted on the previous Wednesday. This was higher for patients admitted with a medical primary diagnosis.