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Emergency medical admissions, deaths at weekends and the public holiday effect. Cohort study
  1. Stacy Smith1,
  2. Ananda Allan2,
  3. Nicola Greenlaw3,
  4. Sian Finlay1,
  5. Chris Isles1
  1. 1Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  2. 2Department of Public Health, Dumfries and Galloway Health Board, Crichton Hall, Dumfries, UK
  3. 3Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
  1. Correspondence to Professor C Isles, Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK; chris.isles{at}nhs.net

Abstract

Objectives To assess whether mortality of patients admitted on weekends and public holidays was higher in a district general hospital whose consultants are present more than 6 h per day on the acute medical unit with no other fixed clinical commitments.

Design Cohort study.

Setting Secondary care.

Participants All emergency medical admissions to Dumfries and Galloway Royal Infirmary between 1 January 2008 and 31 December 2010.

Methods We examined 7 and 30 day mortality for all weekend and for all public holiday admissions, using all weekday and non-public holiday admissions, respectively, as comparators. We adjusted mortality for age, gender, comorbidity, deprivation, diagnosis and year of admission.

Results 771 (3.8%) of 20 072 emergency admissions died within 7 days of admission and 1780 (8.9%) within 30 days. Adjusted weekend mortality in the all weekend versus all other days analysis was not significantly higher at 7 days (OR 1.10, 95% CI 0.92 to 1.31; p=0.312) or at 30 days (OR 1.07, 95% CI 0.94 to 1.21; p=0.322). By contrast, adjusted public holiday mortality in the all public holidays versus all other days analysis was 48% higher at 7 days (OR 1.48, 95% CI 1.12 to 1.95; p=0.006) and 27% higher at 30 days (OR 1.27, 95% CI 1.02 to 1.57; p=0.031). Interactions between the weekend variable and the public holiday variable were not statistically significant for mortality at either 7 or 30 days.

Conclusions Patients admitted as emergencies to medicine on public holidays had significantly higher mortality at 7 and 30 days compared with patients admitted on other days of the week.

  • emergency department

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