The effect of the weekend upon admissions to General Medicine

A reduction in the provision of hospital services on the weekend probably explains higher mortality for patients who are either admitted to hospital or undergo procedures on the weekend. The aim was to examine the effect of the day of the week of admission (DOWOA) upon the efficiency and quality of care for a cohort of General Medical inpatients.

Electronic records were selected for unplanned adult admissions to 2 large public hospitals in Adelaide, South Australia, July 2012 to June 2017.

The cohort consisted of 50 323 records. The number of admissions on each day of the week differed significantly from 6389 on Sundays to 7548 on Thursdays (P < 0.001). Discharges were most frequent on Fridays, and fewest occurred on weekends (P < 0.001) especially if aged over 80 years, if they had significant comorbidity or if they were discharged to a residential aged care facility. The DOWOA did not significantly influence the proportion of cases who died in hospital (5.6% to 6.4%; P = 0.47). The DOWOA significantly affected median inpatient length of stay (IPLOS; 3.1 to 3.9 days; P < 0.001). The median inpatient length of stay (IPLOS) matched the number of days from the ensuing weekend to the DOWOA with the longest median IPLOS.

General Medicine has an inpatient mortality unaffected by the DOWOA. Care efficiency, however, follows a weekly cycle. The "weekend effect" for General Medical inpatients is a prolongation in their IPLOS as a result of fewer weekend discharges.