| Title |
Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study
|
|---|---|
| Published in |
Journal of General Internal Medicine, May 2015
|
| DOI | 10.1007/s11606-015-3330-6 |
| Pubmed ID | |
| Authors |
Saul Blecker, Keith Goldfeld, Hannah Park, Martha J. Radford, Sarah Munson, Fritz Francois, Jonathan S. Austrian, R. Scott Braithwaite, Katherine Hochman, Richard Donoghue, Bernard A. Birnbaum, Marc N. Gourevitch |
| Abstract |
Hospital care on weekends has been associated with delays in care, reduced quality, and poor clinical outcomes. The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. This was an interrupted time series observational study of adult non-obstetric patients hospitalized at a single academic medical center between January 2011 and January 2014. The study included 18 months prior to and 19 months following the implementation of the intervention. Data were analyzed using segmented regression analysis with adjustment for confounders. The primary outcome was average length of stay. Secondary outcomes included percent of patients discharged on weekends, 30-day readmission rate, and in-hospital mortality rate. The study included 57,163 hospitalizations. Following implementation of the intervention, average length of stay decreased by 13 % (95 % CI 10-15 %) and continued to decrease by 1 % (95 % CI 1-2 %) per month as compared to the underlying time trend. The proportion of weekend discharges increased by 12 % (95 % CI 2-22 %) at the time of the intervention and continued to increase by 2 % (95 % CI 1-3 %) per month thereafter. The intervention had no impact on readmissions or mortality. During the post-implementation period, the hospital was evacuated and closed for 2 months due to damage from Hurricane Sandy, and a new hospital-wide electronic health record was introduced. The contributions of these events to our findings are not known. We observed a lower inpatient census and found differences in patient characteristics, including higher rates of Medicaid insurance and comorbidities, in the post-Hurricane Sandy period as compared to the pre-Sandy period. The intervention was associated with a reduction in length of stay and an increase in weekend discharges. Our longitudinal study also illuminated the challenges of evaluating the effectiveness of a large-scale intervention in a real-world hospital setting. |
X Demographics
The data shown below were collected from the profiles of 6 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 2 | 33% |
| Netherlands | 1 | 17% |
| Unknown | 3 | 50% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 3 | 50% |
| Members of the public | 1 | 17% |
| Scientists | 1 | 17% |
| Science communicators (journalists, bloggers, editors) | 1 | 17% |
Mendeley readers
The data shown below were compiled from readership statistics for 72 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 1% |
| United States | 1 | 1% |
| Unknown | 70 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 11 | 15% |
| Researcher | 7 | 10% |
| Student > Master | 7 | 10% |
| Student > Bachelor | 4 | 6% |
| Librarian | 4 | 6% |
| Other | 16 | 22% |
| Unknown | 23 | 32% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 19 | 26% |
| Nursing and Health Professions | 8 | 11% |
| Social Sciences | 8 | 11% |
| Engineering | 3 | 4% |
| Business, Management and Accounting | 2 | 3% |
| Other | 6 | 8% |
| Unknown | 26 | 36% |
Attention Score in Context
This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 22 December 2016.
All research outputs
#4,723,117
of 24,969,131 outputs
Outputs from Journal of General Internal Medicine
#2,956
of 8,074 outputs
Outputs of similar age
#55,182
of 269,969 outputs
Outputs of similar age from Journal of General Internal Medicine
#35
of 122 outputs
Altmetric has tracked 24,969,131 research outputs across all sources so far. Compared to these this one has done well and is in the 79th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 8,074 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 22.1. This one has gotten more attention than average, scoring higher than 62% of its peers.
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We're also able to compare this research output to 122 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 69% of its contemporaries.