title: Weekend admission and mortality from acute exacerbations of chronic obstructive pulmonary disease in winter.
abstract: Historically, acute medical staffing numbers have been lower on weekends and in winter numbers of medical admissions rise. An analysis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions to Portsmouth Hospitals over a seven-year period was undertaken to examine the effects of admission on a weekend, of winter, and with the opening of a medical admissions unit (MAU). In total, 9,915 admissions with AECOPD were identified. Weekend admissions accounted for 2,071 (20.9%) of cases, winter accounted for 3,026 (30.5%) admissions, and 522 (34.4%) deaths. Adjusted odds ratio (OR) for death on day 1 after winter weekend admission was 2.89 (95% confidence interval (CI) 1.035 to 8.076). After opening the MAU, the OR for death day 1 after weekend winter admission fell from 3.63 (95% CI 1.15 to 11.5) to 1.65 (95% CI 0.14 to 19.01). AECOPD patients have an increased risk of death after admission over a weekend in winter and this effect was reduced by opening a MAU. These findings have implications for the planning of acute care provision in different seasons.
authors.affiliation: Centre for Respiratory Research, University College London. f.brims@ucl.ac.uk
authors.forename: F J H
authors.initials: FJ
authors.lastname: Brims
authors.forename: A
authors.initials: A
authors.lastname: Asiimwe
authors.forename: N P
authors.initials: NP
authors.lastname: Andrews
authors.forename: D
authors.initials: D
authors.lastname: Prytherch
authors.forename: B R
authors.initials: BR
authors.lastname: Higgins
authors.forename: S
authors.initials: S
authors.lastname: Kilburn
authors.forename: A J
authors.initials: AJ
authors.lastname: Chauhan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015986:Confounding Factors, Epidemiologic; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010507:Periodicity; D010561:Personnel Staffing and Scheduling; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis