Weekend Mortality in an Italian Hospital: Immediate versus Delayed Bedside Critical Care Treatment

Antonio Gallo, Anna Anselmi, Francesca Locatelli, Eleonora Pedrazzoli, Roberto Petrilli and Alessandro Marcon
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Antonio Gallo: Cardiology Department, “Magalini” Hospital, “AULSS 9 Scaligera” Veneto Region, Villafranca di Verona, 37069 Verona, Italy
Anna Anselmi: Cardiology Department, “Sacro Cuore Don Calabria” Hospital, Negrar, 37024 Verona, Italy
Francesca Locatelli: Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
Eleonora Pedrazzoli: Anesthesia and Intensive Care Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37134 Verona, Italy
Roberto Petrilli: Postgraduate School of Physical Medicine and Rehabilitation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
Alessandro Marcon: Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy

IJERPH, 2022, vol. 19, issue 2, 1-11

Abstract: Background: a number of studies highlighted increased mortality associated with hospital admissions during weekends and holidays, the so–call “weekend effect”. In this retrospective study of mortality in an acute care public hospital in Italy between 2009 and 2015, we compared inpatient mortality before and after a major organizational change in 2012. The new model (Model 2) implied that the intensivist was available on call from outside the hospital during nighttime, weekends, and holidays. The previous model (Model 1) ensured the presence of the intensivist coordinating a Medical Emergency Team (MET) inside the hospital 24 h a day, 7 days a week. Methods: life status at discharge after 9298 and 8223 hospital admissions that occurred during two consecutive periods of 1185 days each (organizational Model 1 and 2), respectively, were classified into “discharged alive”, “deceased during nighttime–weekends–holidays” and “deceased during daytime-weekdays”. We estimated Relative Risk Ratios (RRR) for the associations between the organizational model and life status at discharge using multinomial logistic regression models adjusted for demographic and case-mix indicators, and timing of admission (nighttime–weekends–holidays vs. daytime-weekdays). Results: there were 802 and 840 deaths under Models 1 and 2, respectively. Total mortality was higher for hospital admissions under Model 2 compared to Model 1. Model 2 was associated with a significantly higher risk of death during nighttime–weekends–holidays (IRR: 1.38, 95% CI 1.20–1.59) compared to daytime–weekdays (RRR: 1.12, 95% CI 0.97–1.31) ( p = 0.04). Respiratory diagnoses, in particular, acute and chronic respiratory failure (ICD 9 codes 510–519) were the leading causes of the mortality excess under Model 2. Conclusions: our data suggest that the immediate availability of an intensivist coordinating a MET 24 h, 7 days a week can result in a better prognosis of in-hospital emergencies compared to delayed consultation.

Keywords: critical care; consultants; weekend effect; holidays; mortality; respiratory failure (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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