Effect of Time of Hospital Admission on Patient Outcomes

1Northwestern Memorial Hospital, Chicago, IL
2Northwestern Memorial Hospital, Chicago, IL
3Northwestern Memorial Hospital, Chicago, IL
4Northwestern Memorial Hospital, Chicago, IL
5Northwestern Memorial Hospital, Chicago, IL
6Northwestern Memorial Hospital, Chicago, IL
7Northwestern Memorial Hospital, Chicago, IL.

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 66

Background:

Staffing and resource availability in hospitals diminish from day to night. Also, patients admitted at night are often passed off to a new care team in the morning. The impact of this discontinuity on patient care is unknown. Our aim was to compare quality outcomes in patients admitted during the day versus those admitted at night.

Methods:

All general medicine patients at our tertiary‐care hospital are admitted either to a hospitalist service with no residents or to a teaching service. We sampled 883 charts from an ongoing retrospective chart review of all general medicine patients admitted between January 1, 2008, and October 31, 2008, choosing 239 sequential admissions in January, 305 in April, and 339 in August to reflect 3 different points in the academic year. Patients admitted between 7 pm and 7 am were classified as night admissions. We assessed the following outcomes: length of stay, ICU days during hospitalization, repeat ED visit or readmission within 30 days of discharge, poor outcome within the first 24 hours (defined as ICU transfer, cardiac arrest, or death), and hospital charges. Outcomes in patients admitted at night were compared with those admitted during the day, both with and without weighting by case‐mix index (CMI).

Results:

Of 883 charts examined, 848 (96%) had complete data available for analysis. Nearly half (416; 47%) were night admissions. Baseline characteristics were similar between patient groups with regard to age, sex, and CMI. Patients admitted at night had the following outcomes that did not significantly differ from patients admitted during the day: length of stay, 4.06 vs. 4.26 days (P = 0.455), ICU days, 0.10 vs. 0.11 days (P = 0.858), poor outcomes within 24 hours of admission, 1.4% vs. 1.6% (P = 0.833), and total charges, $25,499 vs. $26,800 (P = 0.431). When weighted for CMI, there was a trend toward night admissions having more ED visits within 30 days of discharge (22.0% vs. 17.4%, P = 0.082), and the 30‐day readmission rate was significantly higher for patients admitted at night (19.5% vs. 14.6%, P = 0.05).

Conclusions:

In a sample of general medicine patients during a 10‐month period at 1 academic medical center, we found no differences in many quality indicators based on time of hospital admission, except patients admitted at night were more likely to be readmitted within 30 days. If confirmed, our results could have implications for hospital night staffing and admitting team policies.

Author Disclosure:

A. Marouni, none; R. Khanna, none; K. Wachsberg, none; L. Lindquist, none; J. Feinglass, none; D. Wayne, none; M. Williams, none.

To cite this abstract:

Marouni A, Khanna R, Wachsberg K, Lindqist L, Feinglass J, Wayne D, Williams M. Effect of Time of Hospital Admission on Patient Outcomes. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 66. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/effect-of-time-of-hospital-admission-on-patient-outcomes/. Accessed April 25, 2019.

« Back to Hospital Medicine 2009, May 14-17, Chicago, Ill.