Risk of death or readmission among people discharged from hospital on Fridays

Carl van Walraven; Chaim M. Bell

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Re: Significant or meaningful ?
Carl van Walraven

Posted on: 04 July 2002
Significant or meaningful ?
Axel Ellrodt

Posted on: 28 June 2002
surgery on Friday??
Cecile F. Batchelor

Posted on: 25 June 2002

Posted on: (4 July 2002)

Re: Significant or meaningful ?
Carl van Walraven, Physician, Scientist
Dr. Ellrodt is correct when he points out the absolute differences in adjusted 30-day death or urgent readmission between Wednesday and Friday is small. Overall, the event rate was 7.1%. A 4% relative increase brings the event rate up to 7.2% This is a small increase. The table in our study shows that day of discharge has a weaker association with outcome than the other factors that we studied.
We believe th...
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Dr. Ellrodt is correct when he points out the absolute differences in adjusted 30-day death or urgent readmission between Wednesday and Friday is small. Overall, the event rate was 7.1%. A 4% relative increase brings the event rate up to 7.2% This is a small increase. The table in our study shows that day of discharge has a weaker association with outcome than the other factors that we studied.
We believe that the importance of our findings will stem from an exploration of why such differences exist. We believe that further study is required to determine if care for Friday discharges systematically differ from discharges on other days and whether these differences explain the change in outcomes. We hope that this will shed more light upon why bad things happen to some patients and identify interventions to improve patient outcomes.
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Competing Interests: None declared.
Posted on: (28 June 2002)

Significant or meaningful ?
Axel Ellrodt, MD
van Walraven and Bell have studied more than 2.4 million patient discharges from hospital. They found that those patients discharged on Fridays were significantly more likely to have an event (hazard ratio 1.04, 95% confidence interval 1.02–1.05).
Maybe I'm overlooking something but a hazard ratio of 1.04 does not look so much important although the huge number of patients makes it significant. The hazard is t...
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van Walraven and Bell have studied more than 2.4 million patient discharges from hospital. They found that those patients discharged on Fridays were significantly more likely to have an event (hazard ratio 1.04, 95% confidence interval 1.02–1.05).
Maybe I'm overlooking something but a hazard ratio of 1.04 does not look so much important although the huge number of patients makes it significant. The hazard is the slope of the survival curve – a measure of how rapidly subjects are readmitted (or die). If the hazard ratio is 2.0, then the rate of readmition or death in one discharge day group is twice the rate in the other group. If the hazard ratio is 1.02 to 1.05 , the risk for readmission or death is 1.02 to 1.O5 more likely on fridays than on wednesdays. It should be stressed that although 2% or worse, 4% of discharged patients is not nothing , it is not as dramatic an issue as the title suggests . If I'm not mistaken.
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Competing Interests: None declared.
Posted on: (25 June 2002)

surgery on Friday??
Cecile F. Batchelor, Reg. Nurse
I was extremely interested in your report on discharges on Fridays.I would be inclined to think that patients are probably rushed through with less attention paid to details for their homecare.Why not order a VON visit on the weekend to counteract this problem? I would also like to know if the same authors of this report might consider studying the effects of major surgery being done on Fridays. I had complications af...
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I was extremely interested in your report on discharges on Fridays.I would be inclined to think that patients are probably rushed through with less attention paid to details for their homecare.Why not order a VON visit on the weekend to counteract this problem? I would also like to know if the same authors of this report might consider studying the effects of major surgery being done on Fridays. I had complications after a hip replacement(dislocation)on a Friday, and nothing was done until the surgeon returned on the Monday! Thank you for taking my letter.
Cecile Batchelor Montreal, Quebec
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Competing Interests: None declared.