Weekend Hospitalizations Increase Likelihood of Hospital-Acquired Conditions

Being admitted to the hospital on the weekend is associated with an increased likelihood of a hospital-acquired condition, which in turn increases cost and length of stay, reported researchers from the University of Southern California.

In a paper published in the BMJ, Frank J. Attenello, MD, and colleagues found that the probability of having at least one hospital-acquired condition was 25% higher for patients admitted on the weekend compared with the weekdays. They used data from the 2002 to 2010 extracts of the Nationwide Inpatient Sample, which captures 20% of all US hospital discharges.

“Hospital acquired conditions are events thought to be preventable through effective hospital systems and administrative processes,” the authors wrote. “However, healthcare delivery may be most susceptible to the occurrence of these conditions at times when staffing or standard leadership is reduced.”

During the weekend, the total number of hospital staff and available expertise diminishes, they explained. So while the frequency of hospital-acquired conditions is 3.7% during the weekday, it increases to 5.7% among weekend admissions. Plus, at least one hospital-acquired condition is associated with an 83% likelihood of increased charges and a 38% likelihood of prolonged length of stay.

After adjusting for patient, hospital, and severity, the researchers determined that the probability of having at least one hospital-acquired condition was 25% higher for patients admitted on the weekend. While day of admission was the strongest predictor for complications, teaching status (i.e. teaching or non-teaching institutions) was also significant.

Younger patients and those from a minority ethnic group were less likely to incur a hospital-acquired condition and females were 12% less likely than males.

There were differences between the admissions on the weekend and during the weekday. Weekend admissions came from the emergency department and “were associated with more severe problems in terms of admission type, admission source, and All Patient Refined Disease Related Group Severity Status,” Dr Attenello and his colleagues wrote.

Falls or trauma were the most common hospital-acquired condition, accounting for 85% of the total, followed by pressure ulcers, and catheter-associated urinary tract infections. Patients with at least one hospital-acquired condition were charged a mean of $48,788, which is 76% higher than the mean charge for patients with no hospital-acquired condition, and stayed 6.56 days, up from 4.53 days.