Mortality among patients admitted to hospitals on weekends as compared with weekdays

Background: The level of staffing in hospitals is often lower on weekends t han on weekdays, despite a presumably consistent day-to-day burden of disea se. It is uncertain whether in-hospital mortality rates among patients with serious conditions differ according to whether they are admitted on a week end or on a weekday. Methods: We analyzed all acute care admissions from emergency departments i n Ontario, Canada, between 1988 and 1997 (a total of 3,789,917 admissions). We compared in-hospital mortality among patients admitted on a weekend wit h that among patients admitted on a weekday for three prespecified diseases : ruptured abdominal aortic aneurysm (5454 admissions), acute epiglottitis (1139), and pulmonary embolism (11,686) and for three control diseases: myo cardial infarction (160,220), intracerebral hemorrhage (10,987), and acute hip fracture (59,670), as well as for the 100 conditions that were the most common causes of death (accounting for 1,820,885 admissions). Results: Weekend admissions were associated with significantly higher in-ho spital mortality rates than were weekday admissions among patients with rup tured abdominal aortic aneurysms (42 percent vs. 36 percent, P<0.001), acut e epiglottitis (1.7 percent vs. 0.3 percent, P=0.04), and pulmonary embolis m (13 percent vs. 11 percent, P=0.009). The differences in mortality persis ted for all three diagnoses after adjustment for age, sex, and coexisting d isorders. There were no significant differences in mortality between weekda y and weekend admissions for the three control diagnoses. Weekend admission s were also associated with significantly higher mortality rates for 23 of the 100 leading causes of death and were not associated with significantly lower mortality rates for any of these conditions. Conclusions: Patients with some serious medical conditions are more likely to die in the hospital if they are admitted on a weekend than if they are a dmitted on a weekday. (N Engl J Med 2001;345:663-8.) Copyright (C) 2001 Mas sachusetts Medical Society.