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Do Patient Safety Indicators Explain The Increased Mortality Associated With Weekend Admission?
Rocco Ricciardi1, *Jason Nelson2, Peter W Marcello1, Patricia L Roberts1, Thomas E Read1, *Jason F Hall1, *Todd D Francone1, David J Schoetz1
1Lahey Hospital & Medical Center, Burlington, MA;2Tufts University, Boston, MA

Objective: To determine the differential role of Patient Safety Indicator (PSI) events on mortality following weekend as compared to weekday admission.
Design: Retrospective cohort.
Setting: Nationwide Inpatient Sample hospitals.
Patients: All patients treated for non-elective indications from 1/2003-12/2008.
Main Outcome Measures:
Agency for Healthcare Research and Quality PSI events and inpatient mortality.
Results: There were 28,236,749 patients evaluated with 428,685 (1.5%) experiencing PSI events. The most common PSIs were pressure ulcers, pulmonary embolism, and accidental punctures. Patients who experienced a PSI were older, more likely to have Medicare or Medicaid insurance, and higher comorbidity scores. In the sampled population, a total of 6,550,490 patients (23%) were admitted on a weekend with a 15% higher mortality rate as compared to patients admitted on weekdays. The rate of PSI was the same for patients admitted on weekends as compared to weekdays (1.5%). However, the risk of mortality was 7% higher if a PSI event occurred to a patient admitted on a weekend as compared to a weekday. In addition, compared to patients admitted on weekdays, patients admitted on weekends had a 36% higher risk of postoperative wound dehiscence, 19% greater risk of death in a low mortality diagnostic related group, 19% increased risk of postoperative hip fracture, and 8% elevated risk of surgical inpatient death.
Conclusions: Risk adjusted data reveal that PSIs such as death in a low mortality diagnostic related group, postoperative wound dehiscence, and postoperative hip fracture are substantially higher among patients admitted on weekends. The considerable differences in death following PSI events in patients admitted on weekends as compared to weekdays indicate that responses to adverse events may be less effective on weekends.


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