Emergency medical admissions, deaths at weekends and the public holiday effect. Cohort study

Objectives To assess whether mortality of patients admitted on weekends and public holidays was higher in a district general hospital whose consultants are present more than 6h per day on the acute medical unit with no other fixed clinical commitments. Design Cohort study. Setting Secondary care. Participants All emergency medical admissions to Dumfries and Galloway Royal Infirmary between 1 January 2008 and 31 December 2010. Methods We examined 7 and 30day mortality for all weekend and for all public holiday admissions, using all weekday and non-public holiday admissions, respectively, as comparators. We adjusted mortality for age, gender, comorbidity, deprivation, diagnosis and year of admission. Results 771 (3.8%) of 20072 emergency admissions died within 7days of admission and 1780 (8.9%) within 30days. Adjusted weekend mortality in the all weekend versus all other days analysis was not significantly higher at 7days (OR 1.10, 95% CI 0.92 to 1.31; p=0.312) or at 30days (OR 1.07, 95% CI 0.94 to 1.21; p=0.322). By contrast, adjusted public holiday mortality in the all public holidays versus all other days analysis was 48% higher at 7days (OR 1.48, 95% CI 1.12 to 1.95; p=0.006) and 27% higher at 30days (OR 1.27, 95% CI 1.02 to 1.57; p=0.031). Interactions between the weekend variable and the public holiday variable were not statistically significant for mortality at either 7 or 30days. Conclusions Patients admitted as emergencies to medicine on public holidays had significantly higher mortality at 7 and 30days compared with patients admitted on other days of the week.