The weekend effect - How can it be mitigated? Introduction of a consultant-delivered emergency general surgical service.

Somasundram, Khevan and Neville, Jonathan J and Sinha, Yashashwi and Agarwal, Tushar and Raje, Durgesh and Sinha, Ashish and Sheth, Hemant (2020) The weekend effect - How can it be mitigated? Introduction of a consultant-delivered emergency general surgical service. Annals of medicine and surgery (2012), 57. pp. 315-320. ISSN 2049-0801.

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Abstract

Background

Poorer patient outcomes for emergency general surgery have been observed in patients admitted to hospital over the weekend. This paper reports the outcomes of a Consultant-delivered service model for weekend admissions and its impact for patients undergoing emergency laparotomy.

Methods

Operative data was analysed from a prospectively collected database over 5-years. Primary outcome measures were 30-day all-cause mortality and Clavien-Dindo class ≥2 morbidity. Secondary outcomes included time from admission to diagnostic imaging and time to surgery, post-operative length of stay and requirement for Intensive Care Unit admission.

Results

263 patients underwent an emergency laparotomy. Overall 30-day mortality was 4.6% and all-cause morbidity was 55.9%. The most common indications for laparotomy were mechanical small bowel obstruction (32.7%) and hollow viscus perforation (30.4%) of the 263 emergency laparotomies, 92 patients in the cohort were weekend admissions (Saturday or Sunday). There was no significant difference amongst patients admitted during the weekend in ASA grade, age, gender, or proportion of patients receiving a pre-operative computed tomography scan, when compared to those during the week. Compared to weekdays, weekend admission was not associated with a significant difference in mortality (5.3% and 3.3%, respectively p = 0.458), all-cause morbidity (p = 0.509), post-operative length of stay (p = 0.681), or Intensive Care Unit admission (p = 0.761).

Conclusion

A Consultant Surgeon delivered emergency service can avoid the poor patient outcomes associated with weekend admissions and the 'weekend effect'.

Item Type: Article
Subjects: WA Patients. Primary care. Medical profession. Forensic medicine
WD Diseases and disorders of systemic, metabolic or environmental origin > WD400 Emergency medicine
Divisions: Planned IP Care > General Surgery
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 11 Sep 2020 15:46
Last Modified: 11 Sep 2020 15:46
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3420

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