title: Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study.
abstract: BACKGROUND
  Hospital care on weekends has been associated with delays in care, reduced quality, and poor clinical outcomes.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends.
  
  
  METHODS
  This was an interrupted time series observational study of adult non-obstetric patients hospitalized at a single academic medical center between January 2011 and January 2014. The study included 18 months prior to and 19 months following the implementation of the intervention. Data were analyzed using segmented regression analysis with adjustment for confounders.
  
  
  METHODS
  The primary outcome was average length of stay. Secondary outcomes included percent of patients discharged on weekends, 30-day readmission rate, and in-hospital mortality rate.
  
  
  RESULTS
  The study included 57,163 hospitalizations. Following implementation of the intervention, average length of stay decreased by 13 % (95 % CI 10-15 %) and continued to decrease by 1 % (95 % CI 1-2 %) per month as compared to the underlying time trend. The proportion of weekend discharges increased by 12 % (95 % CI 2-22 %) at the time of the intervention and continued to increase by 2 % (95 % CI 1-3 %) per month thereafter. The intervention had no impact on readmissions or mortality. During the post-implementation period, the hospital was evacuated and closed for 2 months due to damage from Hurricane Sandy, and a new hospital-wide electronic health record was introduced. The contributions of these events to our findings are not known. We observed a lower inpatient census and found differences in patient characteristics, including higher rates of Medicaid insurance and comorbidities, in the post-Hurricane Sandy period as compared to the pre-Sandy period.
  
  
  CONCLUSIONS
  The intervention was associated with a reduction in length of stay and an increase in weekend discharges. Our longitudinal study also illuminated the challenges of evaluating the effectiveness of a large-scale intervention in a real-world hospital setting.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA. saul.blecker@nyumc.org.|Department of Medicine, New York University Langone Medical Center, New York, NY, USA. saul.blecker@nyumc.org.
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Goldfeld
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.|Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.affiliation: Department of Network Integration, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Munson
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Fritz
authors.initials: F
authors.lastname: Francois
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Austrian
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.|Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hochman
authors.affiliation: Department of Strategy, Planning and Business Development, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Donoghue
authors.affiliation: Executive Hospital Administration, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Birnbaum
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000592:standards; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration* / Q000592:standards; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006302:Health Services Research / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D009518:New York; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*; D013997:Time Factors
keywords: Health care delivery; Hospital medicine; Natural disaster; Variations