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Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

  • Rashmi Patel (a1), Edward Chesney (a1), Alexis E. Cullen (a2), Alex D. Tulloch (a3), Matthew Broadbent (a4), Robert Stewart (a5) and Philip McGuire (a6)...
Abstract
Background

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.

Aims

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

Method

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.

Results

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.

Conclusions

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.

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Copyright
Corresponding author
Rashmi Patel, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. Email: rcpsych@rpatel.co.uk
Footnotes
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These authors contributed equally to the work.

Declaration of interest

The CRIS team members M.B. and R.S. have received research funding from Roche, Pfizer, Johnson & Johnson and Lundbeck. P.M. has received research funding from Janssen, Sunovion, GW and Roche.

Footnotes
References
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Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

  • Rashmi Patel (a1), Edward Chesney (a1), Alexis E. Cullen (a2), Alex D. Tulloch (a3), Matthew Broadbent (a4), Robert Stewart (a5) and Philip McGuire (a6)...
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eLetters

Improving weekend community services could potentially help avoid unnecessary hospital admissions

Feras A Mustafa, Psychiatrist, Northamptonshire Healthcare NHS Foundation Trust
02 May 2016

Weekend psychiatric admissions have been shown to be associated with shorter duration, less compulsion, fewer seclusions and reduced mortality (1). These more favourable outcomes suggest that less unwell patients are being admitted to hospital at weekends compared with weekdays, probably due to reduced community services. The study by Patel et al has further revealed that patients with certain characteristics such as female gender, ethnic minority and those admitted from sources other than home, are more likely to be admitted at weekends (1). Thus, one could speculate that mental health professionals, operating with limited resources at weekends, have a lower threshold for admitting patients whom they perceive as vulnerable. Hence, investing in improved weekend community services could potentially help avoid unnecessary hospital admissions.

Nonetheless, there is a couple of methodological issues that require consideration. First, weekends effectively start on Friday afternoon with reduced, or on-call, arrangements replacing regular services till Monday morning. Therefore, admissions that took place between Friday afternoon and Saturday morning during the nine-year study period were in reality exposed to the weekend effect, yet they were treated as weekday admissions which may have potentially attenuated the differences between the two admission categories.

Second, the study examined hospital admissions between 2006 and 2015, a period which coincided with significant reforms to mental health and social services as well as the introduction of the new mental health act. It therefore would have been informative to show differences between weekend and weekday admissions over individual years and whether there have been any trends over time.

References

1Patel R, Chesney E, Cullen AE, Tulloch AD, Broadbent M, Stewart R, et al. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital. Br J Psychiatry April 2016, DOI: 10. 1192/bjp.bp.115. 180307

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Conflict of interest: None Declared

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