Crossing the Chasm of Weekend Effect by Hospitalists: A Three‐Year Quasi‐Experimental Study

Background:

The notorious weekend effect compromises quality of care. However, the implementation of hospitalist system with a 24 hour/7 day coverage may erase the adverse weekend effect.

Methods:

A quasi‐experimental study with propensity score matching of a three‐year general medicine cohort was conducted in a medical center. Patients admitted on weekdays were compared to those admitted on weekends in terms of clinical characteristics, hospital course, and outcomes, which included intensive care unit (ICU) admission, unexpected cardio‐pulmonary resuscitation, and in‐hospital mortality. Propensity score matching was used for differing demographics. Two historical general medicine cohorts cared for by non‐hospitalists, using institutional medical records and nationwide health insurance reasearch database (NHIRD), were the comparison groups.

Results:

From January 2010 to December 2012, there were 3315 hospitalized patients, including 898 (27.1%) admitted on weekends. Patients admitted on weekends had more severe triage levels at the emergency department, lower Barthel index (48.8 vs. 52.9, p=0.013), and more pneumonia diagnosis on admission that warranted matching for comparison. The length of hospitalization, ICU admission rate, cardio‐pulmonary resuscitation (CPR) rate, and hospital mortality did not differ between weekday and weekend admissions before matching. After propensity score matching, the two groups had similar ICU admission rate, CPR rate, and hospital mortality. However, the weekend group had longer hospital stay (9.9 vs. 11.3 days, p=0.013). The institutional comparison group showed higher hospital mortality rate on weekends, and the NHIRD data including all medical centers in Taipei area showed higher ICU admission rate, CPR rate and hospital mortality on weekends. Both historical comparison cohorts showed significant weekend effects.

Conclusions:

For patients requiring acute medical care, the quality of weekend admission can be maintained by implementing the hospitalist system. The 24/7 coverage of hospitalists bridges the quality chasm on weekends, although the dip in efficiency on weekends warrants further study.