title: Is the presence of medical trainees associated with increased mortality with weekend admission?
abstract: BACKGROUND
  Several studies have demonstrated increased inhospital mortality following weekend admission. We hypothesized that the presence of resident trainees reduces the weekend mortality trends.
  
  
  METHODS
  We identified all patients with a non-elective hospital admission from 1/1/2003 through 12/31/2008. We abstracted vital status on discharge and calculated the Charlson comorbidity score for all inpatients. We compared odds of inpatient mortality following non-elective admission on a weekend day as compared to a weekday, while considering diagnosis, patient characteristics, comorbidity, hospital factors, and care at hospitals with resident trainees.
  
  
  RESULTS
  Data were available for 48,253,968 patient discharges during the six-year study period. The relative risk of mortality was 15% higher following weekend admission as compared to weekday admission. After adjusting for diagnosis, age, sex, race, income level, payer, comorbidity, and weekend admission the overall odds of mortality was higher for patients in hospitals with fewer nurses and staff physicians. Mortality following a weekend admission for patients admitted to a hospital with resident trainees was significantly higher (17%) than hospitals with no resident trainees (p < 0.001).
  
  
  CONCLUSIONS
  Low staffing levels of nurses and physicians significantly impact mortality on weekends following non-elective admission. Conversely, patients admitted to hospitals with more resident trainees had significantly higher mortality following a weekend admission.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Clinic, Tufts University, 41 Mall Rd, Burlington, MA 01805, USA. rocco.ricciardi@lahey.org.
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
authors.forename: Jason
authors.initials: J
authors.lastname: Nelson
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Roberts
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Read
authors.forename: David J
authors.initials: DJ
authors.lastname: Schoetz
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D013997:Time Factors; D014481:United States; D000078329:Workforce