Highlights
- •The pattern of mortality for admissions can be represented by mathematical models
- •The pattern is identical for weekday and weekend admissions
- •Mortality is higher for weekend admissions at all time points
- •Case complexity and acuity are major determinants of survival
Abstract
Background
The aim of this study was to detail the time profile and frequency distribution of
mortality following an emergency admission and to compare these for weekday and weekend
admissions.
Methods
We profiled in-hospital deaths following emergency medical admission between 2002
and 2014. We determined the frequency distribution, time pattern, causality and influence
of day of admission on mortality out to 120 days. We utilized a multivariable regression model (logistic for in-hospital mortality
and truncated Poisson for count data) to adjust for major predictor variables.
Results
There were 82,368 admissions in 44,628 patients with 4587 in-hospital deaths. The
30-day in-hospital mortality declined from 8.2% in 2002 to 3.7% in 2014. The mortality
pattern showed an exponential decay over time; the time to death was best described
by the three-parameter Weibull model. The calculated time to death for the 5th, 10th,
25th, 50th, 75th, and 90th centiles were 0.5, 1.2, 3.8, 11.1, 26.3 and 49.3 days. Acute Illness Severity Score, Chronic Disabling Disease Score, Charlson Co-Morbidity
Index and Sepsis status were associated with mortality. The risk of death was initially
high, lower by day 3, and showed a cumulative increase over time. The mortality pattern
was very similar between a weekday or weekend admission; however, the risk of death
was greater at all time points between 0 and 120 days for patients admitted at a weekend OR 1.08 (95% CI 1.01–1.15).
Conclusion
We have demonstrated the pattern of mortality following an emergency admission. The
underlying pattern is similar between weekday and weekend admissions.
Keywords
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References
- RCPE UK consensus statement on acute medicine, November 2008.Br J Hosp Med (Lond). 2009; 70: S6-S7
- Long-term Outcome of an AMAU – a Decade’s Experience.QJM. 2014; 107: 43-49
- Impact of an acute medical admission unit on hospital mortality: a 5-year prospective study.QJM. 2008; 101: 457-465
- Patient risk profiling in acute medicine – the way forward?.QJM. 2015; 108: 689-696
- Effectiveness of acute medical units in hospitals: a systematic review.International J Qual Health Care. 2009; 21: 397-407
- Acute medical units: review of evidence.Eur J Intern Med. 2011; 22: 344-347
- Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.PLoS One. 2013; 8e61476
- Use of Western Australian linked hospital morbidity and mortality data to explore theories of compression, expansion and dynamic equilibrium.Aust Health Rev. 2007; 31: 571-581
- The increased mortality associated with a weekend emergency admission is due to increased illness severity and altered case-mix.Acute Med. 2011; 10: 181-186
- Weekend mortality for emergency admissions. A large, multicentre study.Qual Saf Health Care. 2010; 19: 213-217
- Do hospitals provide lower quality care on weekends? Health Serv res.Health Serv Res. 2007; 42: 1589-1612
- Quality and effectiveness of an emergency department during weekends.Emerg Med J. 2004; 21: 573-574
- Mortality among patients admitted to hospitals on weekends as compared with weekdays.N Engl J Med. 2001; 345: 663-668
- Deprivation index and dependency ratio are key determinants of emergency medical admission rates.Eur J Intern Med. 2015; 26: 709-713
- Social deprivation, population dependency ratio and an extended hospital episode — insights from acute medicine.Eur J Intern Med. 2015; 26: 714-719
- Do the poor still cost more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001/2 to 2006/7.(Available from:)Date: 2009
- Higher mortality in areas of lower socioeconomic position measured by a single index of deprivation in Japan.Public Health. 2007; 121: 163-173
- Socio-economic deprivation and duration of hospital stay in severe mental disorder.Br J Psychiatry. 2006; 188: 581-582
- Deprivation as an outcome determinant in emergency medical admissions.QJM. 2013; 106: 245-251
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Disabling disease codes predict worse outcomes for acute medical admissions.Intern Med J. 2014; 44: 546-553
- Chronic disabling disease-impact on outcomes and costs in emergency medical admissions.QJM. 2015; 108: 387-396
- An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling.QJM. 2010; 103: 23-32
- Predicting outcomes in emergency medical admissions — role of laboratory data and co-morbidity.Acute Med. 2012; 2: 59-65
- Blood cultures in emergency medical admissions: a key patient cohort.Eur J Emerg Med. 2016; 23: 38-43
- Using HIPE data as a research and planning tool: limitations and opportunities.Ir J Med Sci. 2005; 174 (discussion): 52-57
- A critical evaluation of HIPE data.Ir Med J. 2012; 105: 21-23
- Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of hospital episode statistics from 2005–2010.BMC Health Serv Res. 2014; 14: 270
- Prediction of mortality 1 year after hospital admission.QJM. 2012; 105: 847-853
- A critique of Geoffrey Rose's 'population strategy' for preventive medicine.J R Soc Med. 1995; 88: 607-610
- The impact of weekends on outcome for acute exacerbations of COPD.Eur Respir J. 2012; 39: 46-50
Article info
Publication history
Published online: August 18, 2016
Accepted:
August 5,
2016
Received in revised form:
August 3,
2016
Received:
April 12,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
