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

Nina Sahlertz Kristiansen; Pia Kjær Kristensen; Bente Mertz Nørgård; Jan Mainz; Søren Paaske Johnsen

doi:10.1093/intqhc/mzw037

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

Nina Sahlertz Kristiansen^*
, Pia Kjær Kristensen
, Bente Mertz Nørgård
, Jan Mainz
, Søren Paaske Johnsen

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

38 Citations (Scopus)

Abstract

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.

DESIGN: Cohort study.

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

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

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

MAIN OUTCOME MEASURES: 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.

Original language	English
Article number	mzw037
Journal	International Journal for Quality in Health Care
Volume	28
Issue	3
Pages (from-to)	324-331
Number of pages	8
ISSN	1353-4505
DOIs	https://doi.org/10.1093/intqhc/mzw037
Publication status	Published - Jun 2016

Keywords

Hip fracture
Mortality
Off-hours-effect
Performance measures
Quality of care
Weekend-effect

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@article{24389463fa834307af0fba45a3945e19,

title = "Off-hours admission and quality of hip fracture care: a nationwide cohort study of performance measures and 30-day mortality",

abstract = "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.DESIGN: Cohort study.SETTING: Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries.PARTICIPANTS: Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305).EXPOSURE: Off-hours: weekday evenings and nights, and weekends.MAIN OUTCOME MEASURES: 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.",

keywords = "Hip fracture, Mortality, Off-hours-effect, Performance measures, Quality of care, Weekend-effect",

author = "Kristiansen, \{Nina Sahlertz\} and Kristensen, \{Pia Kj{\ae}r\} and N{\o}rg{\aa}rd, \{Bente Mertz\} and Jan Mainz and Johnsen, \{S{\o}ren Paaske\}",

year = "2016",

month = jun,

doi = "10.1093/intqhc/mzw037",

language = "English",

volume = "28",

pages = "324--331",

journal = "International Journal for Quality in Health Care",

issn = "1353-4505",

publisher = "Oxford University Press",

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}

Off-hours admission and quality of hip fracture care: a nationwide cohort study of performance measures and 30-day mortality. / Kristiansen, Nina Sahlertz; Kristensen, Pia Kjær; Nørgård, Bente Mertz et al.
In: International Journal for Quality in Health Care, Vol. 28, No. 3, mzw037, 06.2016, p. 324-331.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Off-hours admission and quality of hip fracture care

T2 - a nationwide cohort study of performance measures and 30-day mortality

AU - Kristiansen, Nina Sahlertz

AU - Kristensen, Pia Kjær

AU - Nørgård, Bente Mertz

AU - Mainz, Jan

AU - Johnsen, Søren Paaske

PY - 2016/6

Y1 - 2016/6

N2 - 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.DESIGN: Cohort study.SETTING: Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries.PARTICIPANTS: Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305).EXPOSURE: Off-hours: weekday evenings and nights, and weekends.MAIN OUTCOME MEASURES: 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.

AB - 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.DESIGN: Cohort study.SETTING: Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries.PARTICIPANTS: Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305).EXPOSURE: Off-hours: weekday evenings and nights, and weekends.MAIN OUTCOME MEASURES: 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.

KW - Hip fracture

KW - Mortality

KW - Off-hours-effect

KW - Performance measures

KW - Quality of care

KW - Weekend-effect

UR - https://www.scopus.com/pages/publications/84991289634

U2 - 10.1093/intqhc/mzw037

DO - 10.1093/intqhc/mzw037

M3 - Journal article

C2 - 27097886

SN - 1353-4505

VL - 28

SP - 324

EP - 331

JO - International Journal for Quality in Health Care

JF - International Journal for Quality in Health Care

IS - 3

M1 - mzw037

ER -

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

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Keywords

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