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Admission time-dependent variation in mortality in a Danish emergency department

Authors
Karin Biering1, Rasmus Fuglsang Nielsen2 & Noel Pérez3, 1) Danish Ramazzini Centre, Department of Occupational Medicine – University Research Clinic, Regional Hospital West Jutland2) Department of Internal Medicine, Regional Hospital Randers3) Emergency Department, Regional Hospital West Jutland, Denmark

Abstract

Introduction: The inflow of patients in emergency departments (ED) varies over time. If variations are not anticipated, accumulation of patients and treatment delay may occur. This may trigger adverse events causing excess mortality. The aim of this study was to determine if attending the ED after hours and during weekends was associated with an increased mortality.

Methods: We examined the medical records of 5,385 patients. Data were retrieved from the Electronic Patient Journal, the Danish National Patient Registry and the Danish Civil Registration System. Multinomial logistic regression and Cox regression were performed to analyse the associations between attendance time and mortality.

Results: The inflow of patients differed over the hours of the day and the days of the week. The findings tended towards a higher mortality for patients attending the ED during the evening shift than during the dayshifts, and during weekends than during weekdays. Patients attending the ED during the night shift had no excess mortality compared with the dayshifts. The combination of evening shift and weekday and the combination of dayshift and weekend reached significance. Associations with mortality were strongest for in-hospital mortality.

Conclusion: Indications of excess mortality were found for patients attending in the weekend compared with weekdays and in the evening hours compared with night and daytime hours. The causal mechanism is unknown.

Funding: none.

Trial registration: not relevant.

An important goal in emergency healthcare is to prevent adverse events and to postpone mortality. Organising staff in emergency departments (EDs) is complex. Patient inflow and severity are difficult to anticipate during working hours, and planning must rely on expected inflow as well as on the staff’s ability to prioritize the most acute patients by use of a triage system [1]. Furthermore, the accumulation of in-patients adds to the ED workload [2]. A recent large multicentre study found that surgeries with a high patient/nurse ratio were associated with increased mortality [3...
Bib ref: 
Dan Med J 2016;63(1):A5173
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