The Weekend Effect on Evidence-Based Care Adherence Before and After Implementation of Checklist-Based Care in the...

Area of Science:

• Critical Care Medicine
• Healthcare Quality Improvement
• Patient Safety

Background:

• Staffing and resource availability in intensive care units (ICUs) can affect adherence to evidence-based care processes and patient outcomes.
• A potential 'weekend effect' may influence care delivery and patient outcomes, necessitating investigation into its impact and mitigation strategies.

Purpose of the Study:

• To evaluate the existence of a weekend effect on adherence to evidence-based care processes and hospitalization outcomes in ICUs.
• To assess whether implementing a checklist could mitigate potential differences in care processes and outcomes between weekend/holiday and weekday admissions.

Main Methods:

• A post hoc analysis of the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) study dataset was conducted.
• Data from 34 ICUs across 15 countries (2013-2017) were analyzed, comparing care processes and outcomes for weekend/holiday admissions versus weekday admissions, both pre- and post-checklist implementation.
• The primary outcome was the omission of 10 evidence-based care processes; secondary outcomes included mortality and length of stay.

Main Results:

• Pre-intervention, peptic ulcer prophylaxis was omitted more on weekends, while head-of-bed elevation was omitted more on weekdays.
• Post-intervention, peptic ulcer prophylaxis omission rates normalized, but head-of-bed elevation omission increased on weekends, and oral care omission increased on weekends.
• No significant differences in mortality or length of stay were found between weekend/holiday and weekday admissions, either pre- or post-intervention.

Conclusions:

• A weekend effect demonstrably influences adherence to specific care processes in ICUs.
• Checklist implementation led to overall adherence improvements but resulted in the emergence of new disparities while diminishing others.
• Further research into organizational, cultural, and temporal factors is crucial for optimizing consistent care delivery across all times and settings.