Does the "Weekend Effect" Extend to Friday Admissions? An Analysis of Ischemic Stroke Hospitalizations in South Carolina

Laite Chen; Lu Shi; Donglan Zhang; Chenyang Jiang; Khoa Truong

doi:10.3389/fneur.2020.00424

Does the "Weekend Effect" Extend to Friday Admissions? An Analysis of Ischemic Stroke Hospitalizations in South Carolina

Front Neurol. 2020 Jun 5:11:424. doi: 10.3389/fneur.2020.00424. eCollection 2020.

Authors

Laite Chen¹, Lu Shi², Donglan Zhang³, Chenyang Jiang⁴, Khoa Truong²

Affiliations

¹ School of Medicine, Zhejiang University, Hangzhou, China.
² Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
³ Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, United States.
⁴ Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Abstract

Background: Weekend admission has been found to be associated with higher hospital mortality and longer hospital stay among patients with acute cardiovascular conditions. Whether those admitted on Fridays face similar risk as those admitted on Sundays and Saturdays remain uncertain. Methods: This study used 2012-2013 data from hospital records for nonfatal patients with ischemic stroke in the state of South Carolina. The database contained the records of all hospitalizations in South Carolina except military and federal institutions. Multilevel logistic, negative binomial, and log-linear regression models were performed to explore the temporal pattern by hospital admission on specific day of a week for three outcomes: discharge to hospice care (vs. other alive discharges), length of stay, and total charge, respectively. Each model controlled for the patient age, gender, race/ethnicity, year of hospital admission, season of admission, payer, and Charlson Comorbidity Index. Results: A total of 19,346 nonfatal ischemic stroke hospitalizations were identified. Multilevel logistic regression shows that patients admitted on non-Friday weekdays had a significantly lower odds of being discharged to hospice care as compared with those admitted on Fridays [odds ratio = 0.80, 95% confidence interval (CI) = 0.65-0.99] where there was no significant difference between Friday admissions and weekend admissions. The length of hospital stay for admission on non-Friday weekdays was significantly shorter than that of Friday admissions [incident rate ratio (IRR) = 0.87, 95% CI = 0.84-0.90], whereas longer length of hospital stay was found on weekend admission (IRR = 1.06, 95% CI = 1.02-1.11). Friday admissions were not associated with higher charges as compared with non-Friday weekday admissions. Conclusions: Some hospitalization outcomes admitted on Fridays seemed to have the "weekend effects" too. Further studies are warranted to investigate underlying mechanism for such a difference in outcomes between Friday and other weekdays. Interventions to close the weekend-weekday gap of patient outcomes need to consider the elevated risk on Friday admission.

Keywords: discharge to hospice care; ischemic stroke; length of hospital stay; temporal pattern of hospital outcomes; weekend effect.