Off-hours admission and quality of hip fracture care: a nationwide cohort study of performance measures and 30-day mortality
Higher risks of adverse outcomes have been reported for patients admitted acutely during off-hours. However, in relation to hip fracture, the evidence is inconsistent. We examined whether time of admission influenced compliance with performance measures, surgical delay and 30-day mortality in patients with hip fracture. Cohort study. Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries. Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305). Off-hours: weekday evenings and nights, and weekends. Meeting specific performance measures, surgical delay and mortality. No differences were found in patient characteristics or in meeting performance measures (RRs from 0.99 [95% CI: 0.98-1.01] to 1.01 [95% CI: 0.99-1.02]. When comparing admission on weekdays (evenings and nights vs. days), off-hours admission was associated with a lower risk of surgical delay (adjusted OR 0.75 [95% CI: 0.66-0.85]) while no differences in 30-day mortality was found (adjusted OR 0.91 [95% CI: 0.80-1.04]. When comparing admission during weekends with admission during weekdays, off-hours admission was associated with a higher risk of surgical delay (adjusted OR 1.19 [95% CI: 1.05-1.37]) and a higher 30-day mortality risk (adjusted OR 1.13 [95% CI: 1.04-1.23]. The risk of surgical delay appeared not to explain the excess 30-day mortality. Patients admitted off-hours and on-hours received similar quality of care. The risk of surgical delay and 30 days mortality was higher among patients admitted during weekends; explanations need to be clarified..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:28 |
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| Enthalten in: |
International journal for quality in health care - 28(2016), 3, Seite 324-331 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kristiansen, Nina Sahlertz [VerfasserIn] |
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| Links: |
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| doi: |
10.1093/intqhc/mzw037 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC1978168462 |
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| 245 | 1 | 0 | |a Off-hours admission and quality of hip fracture care: a nationwide cohort study of performance measures and 30-day mortality |
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| 520 | |a Higher risks of adverse outcomes have been reported for patients admitted acutely during off-hours. However, in relation to hip fracture, the evidence is inconsistent. We examined whether time of admission influenced compliance with performance measures, surgical delay and 30-day mortality in patients with hip fracture. Cohort study. Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries. Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305). Off-hours: weekday evenings and nights, and weekends. Meeting specific performance measures, surgical delay and mortality. No differences were found in patient characteristics or in meeting performance measures (RRs from 0.99 [95% CI: 0.98-1.01] to 1.01 [95% CI: 0.99-1.02]. When comparing admission on weekdays (evenings and nights vs. days), off-hours admission was associated with a lower risk of surgical delay (adjusted OR 0.75 [95% CI: 0.66-0.85]) while no differences in 30-day mortality was found (adjusted OR 0.91 [95% CI: 0.80-1.04]. When comparing admission during weekends with admission during weekdays, off-hours admission was associated with a higher risk of surgical delay (adjusted OR 1.19 [95% CI: 1.05-1.37]) and a higher 30-day mortality risk (adjusted OR 1.13 [95% CI: 1.04-1.23]. The risk of surgical delay appeared not to explain the excess 30-day mortality. Patients admitted off-hours and on-hours received similar quality of care. The risk of surgical delay and 30 days mortality was higher among patients admitted during weekends; explanations need to be clarified. | ||
| 540 | |a Nutzungsrecht: © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved. | ||
| 700 | 1 | |a Kristensen, Pia Kjær |4 oth | |
| 700 | 1 | |a Nørgård, Bente Mertz |4 oth | |
| 700 | 1 | |a Mainz, Jan |4 oth | |
| 700 | 1 | |a Johnsen, Søren Paaske |4 oth | |
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| 773 | 1 | 8 | |g volume:28 |g year:2016 |g number:3 |g pages:324-331 |
| 856 | 4 | 1 | |u http://dx.doi.org/10.1093/intqhc/mzw037 |3 Volltext |
| 856 | 4 | 2 | |u http://www.ncbi.nlm.nih.gov/pubmed/27097886 |
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