Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study

Background

Hospital care on weekends has been associated with delays in care, reduced quality, and poor clinical outcomes.

Objective

The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends.

Design and Patients

This was an interrupted time series observational study of adult non-obstetric patients hospitalized at a single academic medical center between January 2011 and January 2014. The study included 18 months prior to and 19 months following the implementation of the intervention. Data were analyzed using segmented regression analysis with adjustment for confounders.

Main Measures

The primary outcome was average length of stay. Secondary outcomes included percent of patients discharged on weekends, 30-day readmission rate, and in-hospital mortality rate.

Key Results

The study included 57,163 hospitalizations. Following implementation of the intervention, average length of stay decreased by 13 % (95 % CI 10–15 %) and continued to decrease by 1 % (95 % CI 1–2 %) per month as compared to the underlying time trend. The proportion of weekend discharges increased by 12 % (95 % CI 2–22 %) at the time of the intervention and continued to increase by 2 % (95 % CI 1–3 %) per month thereafter. The intervention had no impact on readmissions or mortality. During the post-implementation period, the hospital was evacuated and closed for 2 months due to damage from Hurricane Sandy, and a new hospital-wide electronic health record was introduced. The contributions of these events to our findings are not known. We observed a lower inpatient census and found differences in patient characteristics, including higher rates of Medicaid insurance and comorbidities, in the post-Hurricane Sandy period as compared to the pre-Sandy period.

Conclusions

The intervention was associated with a reduction in length of stay and an increase in weekend discharges. Our longitudinal study also illuminated the challenges of evaluating the effectiveness of a large-scale intervention in a real-world hospital setting.KEY WORDS: Health care delivery, Hospital medicine, Variations, Natural disaster