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Objective: We hypothesized that resident trainees reduce the well-described increased mortality of weekend hospital admission.
Design: Retrospective cohort analysis.
Setting: Patients admitted to hospitals in the United States.
Patients: We identified all patients with a non-elective admission from 1/1/2003 through 12/31/2008 in the Nationwide Inpatient Sample. Next, we abstracted vital status on discharge and calculated the Charlson comorbidity score for all inpatients. We then compared odds of inpatient mortality for non-elective admission on the weekend compared to weekday, after adjusting for diagnosis, age, sex, race, income level, payer, and comorbidity. Last, we identified interactions between staffing levels and residency training on mortality during the weekend versus weekday
Main Outcome Measures: Mortality
Results: Data were available for 48,253,968 patient discharges during the six-year study period, of which 26,038,921 were non-elective. The relative risk of mortality was15% higher on the weekend as compared to a weekday. After adjusting for diagnosis, age, sex, race, income level, payer, comorbidity, and weekend admission the overall odds of mortality was higher for patients in hospitals with fewer nurses and staff physicians. Conversely, mortality was higher for patients in hospitals with more beds and more resident trainees on the weekend with interactions identified between weekend mortality and resident trainees. Mortality on the weekend for patients admitted to a hospital with large numbers of resident trainees was 17% higher than hospitals with no resident trainees (p<0.001).
Conclusions: Low staffing levels of nurses and physicians significantly impact mortality on weekends following non-elective admission. Conversely, more resident trainees were also associated with higher mortality on weekends. Staffing levels and resident supervision during weekend patient care is an important area of focus for patient safety.