Weekend Discharge: A Risk Factor For Hospital Readmission?

There is conflicting evidence on the relationship between weekend discharge and hospital readmission rates. Some studies suggest that patients discharged on weekends have a shorter length of stay and lower readmission rates, particularly after specific procedures such as colectomy and hip replacement. However, other research indicates that weekend discharges present unique challenges due to variations in staffing and resources, potentially impacting patient outcomes. Understanding these complexities is crucial for improving discharge practices and ensuring optimal patient care.

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Weekend discharge after major surgery

In California, researchers analysed data for patients who underwent abdominal aortic aneurysm (AAA) repair, colectomy, total hip arthroplasty, and pancreatectomy. They found that overall, 23.3% of patients were discharged on weekends. While there were no significant differences in patient characteristics between weekend and weekday discharges, those discharged on weekends had shorter lengths of stay and were less likely to be discharged to a skilled nursing facility.

The 30-day readmission rates for these procedures ranged from 7.5% to 16.3%similar rates between weekend and weekday discharges for AAA repair and pancreatectomy. Interestingly, weekend discharge was associated with a lower 30-day readmission rate for colectomy and hip replacement.

In Saudi Arabia, studies have also investigated the impact of weekend discharge on readmission rates for cancer patients after major surgery. While the focus was on understanding readmission patterns, no direct comparisons were made between weekend and weekday discharges.

Overall, the conclusion from these studies is that weekend discharge after major surgery is not associated with higher 30- or 90-day readmission rates. This finding contradicts the notion of a "weekend effect," which suggests that reduced staffing levels on weekends may impact patient preparation for discharge.

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The impact of weekend discharge

One study from 2015 examined the association between weekend discharge and hospital readmission rates following major surgery. It analysed data from 128,057 patients who underwent abdominal aortic aneurysm (AAA) repair, colectomy, total hip arthroplasty, and pancreatectomy. The results indicated that weekend discharge was not associated with higher 30- or 90-day readmission rates overall. However, when broken down by procedure type, weekend discharge was associated with a lower 30-day readmission rate for patients undergoing colectomy and hip replacement.

Another study, focusing on patients in California with acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA), found that out of 266,519 patients, 22.5% were discharged on a weekend. Interestingly, the 30-day hospital readmission rates were similar between weekend and weekday discharges for AMI and PNA, while a slight difference was observed for CHF (weekend: 15.4%, weekday: 16.0%). Multivariable logistic regression models further supported that weekend discharge was not associated with increased readmission rates for these conditions.

In contrast, a 2021 study on surgical patients at Veterans Affairs hospitals revealed an association between weekend discharges and excess length of stay. The study found that patients discharged during the week tended to be older and had a greater excess length of stay compared to those discharged over the weekend. This finding may suggest that weekend discharges could be related to shorter hospital stays, potentially due to the unique challenges of discharging patients outside the standard work week.

While the evidence on the impact of weekend discharge is mixed, it is important to consider the potential implications for patient care and resource allocation. Further research is needed to comprehensively understand the relationship between weekend discharge and hospital readmission rates, especially in different patient populations and healthcare settings.

30-day hospital readmission rates

The 30-day hospital readmission rate is a critical metric in healthcare, reflecting the percentage of patients who return to the hospital within 30 days of their initial discharge. This phenomenon carries significant implications for patient care and healthcare system efficiency. Various factors, such as the day of discharge, patient diagnosis, and outpatient follow-up, influence readmission rates.

Weekend discharges have been a particular area of interest in studying readmission rates. Research by Cloyd et al. in 2015 analysed data from 266,519 patients, of whom 60,097 (22.5%) were discharged on weekends. The study found that unadjusted 30-day hospital readmission rates were comparable between weekend and weekday discharges for specific conditions: acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA). The readmission rates for AMI were 21.9% for both weekend and weekday discharges, while CHF rates were 15.4% for weekend and 16.0% for weekday, and PNA rates were 12.1% and 12.4%, respectively. However, multivariable logistic regression models revealed that weekend discharge was not a significant factor associated with readmission for these conditions.

The impact of weekend discharges on readmission rates may vary based on patient characteristics and diagnoses. Some studies have reported worse outcomes for patients admitted on weekends, but the understanding of the effect of weekend discharges is still evolving. Additionally, outpatient follow-up visits after discharge have been identified as a potential strategy to reduce 30-day readmissions. Systematic reviews and meta-analyses have examined the effectiveness of outpatient follow-up visits in reducing readmissions for conditions such as heart failure, chronic obstructive pulmonary disease (COPD), AMI, and stroke. While outpatient follow-up visits can be beneficial, more high-quality research is needed to strengthen the understanding of their impact.

To effectively track and analyse readmission rates, databases such as the HCUP Nationwide Readmissions Database (NRD) in the United States are utilised. The NRD is designed to support analyses of national readmission rates, including discharges for patients with and without repeat hospital visits within a year. The database provides valuable data for researchers and healthcare professionals to identify trends, improve patient care, and develop strategies to minimise preventable readmissions.

Hospital mortality rates

However, the relationship between hospital mortality rates and the day of discharge is less clear. While some studies suggest that patients discharged on weekends have a higher mortality index, indicating higher observed mortality rates, it is challenging to determine whether the day of discharge directly influences the risk of in-hospital mortality.

In a study comparing patients discharged from US hospitals between 2016 and 2018, it was found that patients admitted and discharged on weekends had the highest mortality index. Conversely, patients admitted on weekends but discharged on weekdays had the lowest mortality index. These findings highlight the potential impact of the day of discharge on mortality rates.

Additionally, it is important to consider other factors that may contribute to higher mortality rates during weekends. One suggestion is that patients admitted on weekends could be experiencing more severe illnesses, which would then raise questions about the adequacy of medical care and staffing patterns during these periods.

While the relationship between weekend discharges and hospital mortality rates is complex and requires further investigation, it is clear that there are differences in outcomes for patients admitted and discharged on different days of the week. Understanding these differences can help hospitals improve patient care and safety measures.

Discharge destination

A study by Cloyd et al. (2015) found that patients discharged on weekdays had a longer length of stay and were more frequently discharged to skilled nursing facilities. This suggests that patients discharged during the week may have higher care needs or require additional support post-discharge. However, the study also concluded that weekend discharge was not associated with an increased risk of readmission within 30 days for patients with specific conditions (AMI, CHF, and PNA) in California.

In contrast, a study by Hoang et al. (2019) found that weekend discharge after elective colectomy was associated with a lower 30-day readmission rate. Similarly, patients undergoing colectomy or hip replacement who were discharged on weekends had lower readmission rates compared to those discharged on weekdays. This could be attributed to various factors, such as patient complexity, postoperative care, or differences in hospital protocols and resources between weekdays and weekends.

Additionally, studies focusing on surgical patients discharged from Veterans Affairs hospitals found that weekend discharges were associated with a shorter length of stay. Patients discharged on weekends had fewer excess days in the hospital, indicating that they may have been healthier with less complicated postoperative courses. These findings highlight the potential impact of discharge timing on patient outcomes and the utilisation of healthcare resources.

Overall, while discharge destination is a crucial aspect of patient care, the association between weekend discharge and hospital readmission rates appears complex and may vary depending on patient characteristics, the type of surgery or treatment, and the availability of post-discharge support. Further research is needed to comprehensively understand the relationship between discharge timing and patient outcomes.

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