Clinical outcomes and mortality associated with weekend admission to psychiatric hospital.
Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals.



To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes.



Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week.



There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient -21.1 days, 95% CI -24.6 to -17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week.



Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.
Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK rcpsych@rpatel.co.uk.
Rashmi
R
Patel
Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Edward
E
Chesney
Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Alexis E
AE
Cullen
Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Alex D
AD
Tulloch
Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Matthew
M
Broadbent
Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Robert
R
Stewart
Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Philip
P
McGuire
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult