Adding a new dimension to the weekend effect: an analysis of a national data set of electronic AKI alerts.

Adding a new dimension to the weekend effect: an analysis of a national data set of electronic AKI alerts.

QJM. 2018 Jan 17;:

Authors: Holmes J, Rainer T, Geen J, Williams JD, Phillips AO

Abstract
Background: Increased mortality related to differences in delivery of weekend clinical care is the subject of much debate.
Aims: We compared mortality following detection of AKI on week and weekend days across community and hospital settings. Design. A prospective national cohort study, with AKI identified using the Welsh National electronic AKI reporting system.
Methods: Data was collected on outcome for all cases of adult AKI in Wales between 1st November 2013 and 31st January 2017.
Results: There were a total of 107 298 episodes. Weekday detection of AKI was associated with 28.8% (26 439)90-day mortality compared to 90-day mortality of 31.9% (4551) for AKI detected on weekdays (RR 1.11, 95% CI 1.08-1.14, p < 0.001, HR 1.16 95% CI 1.12-1.20 p < 0.001). There was no "weekend effect" for mortality associated with hospital-acquired AKI (HA-AKI). Weekday detection of community-acquired AKI (CA-AKI) was associated with a 22.6% (10 356) mortality compared with weekend detection of CA-AKI, which was associated with a 28.6% (1619) mortality (RR 1.26 95% CI 1.21 -1.32, p < 0.001, HR 1.34 95% 1.28 - 1.42, p < 0.001). The excess mortality in weekend CA-AKI was driven by CA-AKI detected at the weekend that was not admitted to hospital compared with CA-AKI detected on weekdays which was admitted to hospital (34.5% vs. 19.1%, RR 1.8, 95% CI 1.69-1.91 p < 0.001, HR 2.03 95% CI 1.88-2.19, p < 0.001).
Conclusion: "Weekend effect" in AKI relates to access to in-patient care for patients presenting predominantly to hospital emergency departments with AKI at the weekend.

PMID: 29361145 [PubMed - as supplied by publisher]

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