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Weekend Discharges and Length of Stay Among Veterans Admitted for Chronic Obstructive Pulmonary Disease

Rinne, Seppo T., MD, PhD*,†; Wong, Edwin S., PhD‡,§; Hebert, Paul L., PhD‡,§; Au, David H., MD‡,∥; Lindenauer, Peter K., MD; Neely, Emily L., MPH; Sulc, Christine A., BA; Liu, Chuan-Fen, PhD‡,§

doi: 10.1097/MLR.0000000000000395
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Background: Discharge rates are substantially lower on weekends, though the impact on hospital length of stay (LOS) is not fully understood.

Objectives: The primary objective was to examine the association of weekend discharges with hospital LOS. We also examined the association of weekend discharges with readmission, mortality, and postdischarge follow-up.

Research Design and Methods: A cohort study of 25,301 patients who were admitted to Veterans Affairs hospitals for chronic obstructive pulmonary disease during October 01, 2008–September 30, 2010, including 3845 patients discharged on the weekend (Saturday or Sunday) and 21,456 discharged on weekdays (Monday through Friday).

Results: There were significantly fewer discharges on the weekend (1922 per weekend day vs. 4279 per weekday, P<0.01). Inpatient status during the weekend at any point in hospitalization was associated with an increased LOS of 0.59 day [95% confidence interval (CI), 0.54–0.63 d]. Discharge on the weekend was not associated with increased odds of 30-day hospital readmission [odds ratio (OR)=1.00; 95% CI, 0.90–1.10] or lack of primary care follow-up visit within 14 days of discharge (OR=0.94; 95% CI, 0.85–1.03). However, weekend discharges were significantly associated with lower odds of mortality within 30 days after discharge (OR=0.80; 95% CI, 0.65–0.99).

Conclusions: The presence of fewer weekend discharges was associated with significantly longer hospital lengths of stay. Weekend discharges were not associated with higher readmission rates and had lower rates of mortality compared with weekdays discharges. Identifying methods to increase weekend discharges may create an opportunity to improve hospital efficiency.

*VA Connecticut Health Care System, West Haven

Department of Medicine, Division of Pulmonary and Critical Care, Yale University, New Haven, CT

Department of Veterans Affairs, VA Puget Sound Health Care System

Departments of §Health Services

Medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, WA

Department of Medicine, Baystate Medical Center, Springfield, MA

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Supported by Veterans Affairs clinical research grant: IIR-09-354.

The views expressed here are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

The authors declare no conflict of interest.

Reprints: Seppo T. Rinne, MD, PhD, 950 Campbell Avenue, Building 35a Room 2-234, West Haven, CT 06516. E-mail: seppo.rinne@va.gov.

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