• Int J Qual Health Care · Jun 2016

    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, and Søren Paaske Johnsen.
    • Centre for Quality, Region of Southern Denmark, Middelfart, Denmark Institute of Public Health, University of Southern Denmark, Odense, Denmark.
    • Int J Qual Health Care. 2016 Jun 1; 28 (3): 324-31.

    ObjectiveHigher 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.DesignCohort study.SettingData from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries.ParticipantsDanish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305).ExposureOff-hours: weekday evenings and nights, and weekends.Main Outcome MeasuresMeeting specific performance measures, surgical delay and mortality.ResultsNo 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.ConclusionsPatients 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.© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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