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Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients: A Nationwide Cross-Sectional Study

Huang, Chun-Che MS; Huang, Yu-Tung PhD; Hsu, Nin-Chieh MD; Chen, Jin-Shing MD, PhD; Yu, Chong-Jen MD, PhD

Section Editor(s): Fang., Hai

doi: 10.1097/MD.0000000000002643
Research Article: Observational Study

Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan.

A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays.

Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16–1.39; P < 0.001) and/or mechanical ventilation (OR, 1.25; 95% CI, 1.15–1.35; P < 0.001), cardio-pulmonary resuscitation (OR: 1.45; 95% CI: 1.05–2.01; P = 0.026), and be transferred to the intensive care unit (ICU) (OR: 1.16; 95% CI: 1.03–1.30; P = 0.015) compared with those admitted on weekdays. Weekend-admitted patients also had higher odds of in-hospital mortality (OR: 1.19; 95% CI: 1.09–1.30; P < 0.001) and hospital treatment cost (OR: 1.04; 95% CI: 1.01–1.06; P = 0.008) than weekday-admitted patients.

General internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment.

From the Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei (C-CH); Master Degree Program in Aging and Long-Term Care, Kaohsiung Medical University, Kaohsiung (Y-TH); Department of Internal Medicine (N-CH, C-JY); Division of Hospital Medicine (N-CH, J-SC); Department of Traumatology; and Department of Surgery, National Taiwan University Hospital (J-SC), Taipei, Taiwan.

Correspondence: Nin-Chieh Hsu, Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan (e-mail:

Abbreviations: CCI = Charlson co-morbidity index, CHF = congestive heart failure, CI = confidence interval, COPD = chronic obstructive pulmonary disease, CPR = cardio-pulmonary resuscitation, GEE = generalized estimating equation, ICD-9-CM = International Classification of Diseases Ninth Revision Clinical Modification, ICU = intensive care unit, IHD = ischemic heart disease, IQR = inter-quartile range, LOS = length of hospital stay, NHIA = National Health Insurance Administration, NHIRD = National Health Insurance Research Database, NT$ = new Taiwan dollars, OR = odds ratio, UTI = urinary tract infection.

This study was based in part on data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare, and managed by National Health Research Institutes.

The authors have no funding and conflicts of interest to disclose.

This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received August 30, 2015

Received in revised form November 11, 2015

Accepted January 6, 2016

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