Off-hours admission and quality of hip fracture care: a nationwide cohort study of performance measures and 30-day mortality.
OBJECTIVE
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.


METHODS
Cohort study.


METHODS
Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries.


METHODS
Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305).


METHODS
Off-hours: weekday evenings and nights, and weekends.


METHODS
Meeting specific performance measures, surgical delay and mortality.


RESULTS
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.


CONCLUSIONS
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.
Centre for Quality, Region of Southern Denmark, Middelfart, Denmark Institute of Public Health, University of Southern Denmark, Odense, Denmark.
Nina Sahlertz
NS
Kristiansen
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Orthopaedic Surgery, Hospital Horsens, Horsens, Denmark.
Pia Kjær
PK
Kristensen
Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Bente Mertz
BM
Nørgård
Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
Jan
J
Mainz
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Søren Paaske
SP
Johnsen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010147:Pain Measurement / Q000379:methods; D010343:Patient Admission / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data
hip fracture; mortality; off-hours-effect; performance measures; quality of care; weekend-effect