Weekend admission increased hospital stays for children with leukemia

Issue: January 25, 2015

Children with newly diagnosed acute lymphoblastic or acute myeloid leukemia who were admitted to the hospital on weekends experienced prolonged lengths of stay, delayed time to chemotherapy and a higher risk for respiratory failure, according to results of a retrospective study.

Elizabeth K. Goodman, BA, of the division of oncology at Children’s Hospital of Philadelphia, and colleagues used the Pediatric Health Information System database to identify 10,720 pediatric patients with ALL and 1,323 patients with AML.

When researchers evaluated the timing of patients’ first hospitalizations, they determined 2,009 (16.7%) were admitted to the hospital on a Saturday or Sunday. Patients admitted on a weekend were significantly more likely to have a severe illness (P˂.001) and to require ICU-level of care within the first 2 days of index admission than patients admitted during the week (4.8% vs. 3.1%; P˂.001).

An analysis adjusted for patient demographics, severe illness at admission and hospital-level factors indicated patients who were admitted to the hospital on the weekend were hospitalized for an additional 1.4 days (95% CI, 0.7-2.1) compared with those hospitalized during the week. Length-of-stay was 0.8 days (95% CI, 0.2-1.5) longer for patients with ALL, and 4.9 days (95% CI, 1.5-8.2) longer for patients with AML.

Patients hospitalized on the weekend also faced delayed time to chemotherapy initiation (.4-day increase; 95% CI, 0.3-0.5) and were at increased risk for respiratory failure (OR=1.5; 95% CI, 1.2-1.7).

However, weekend hospitalization was not associated with an increased risk for mortality during the first admission (OR=1; 95% CI, 0.8-1.6).

“Given the increasing need for cost-effective care in medically complex children, these findings highlight a potential area for improvement in patient care and in cost reduction,” Goodman and colleagues concluded. “Hospitals should consider the increased acuity level of index admission of pediatric patients with leukemia when determining allocation of weekend staff and clinical resources. Optimizing weekend resources may not only help to reduce hospital length-of-stays across all weekend admissions but may also ensure the availability of comprehensive care for those weekend admissions with higher acuity.”

The ideal approach to reducing the longer length-of-stay and complications associated with weekend hospitalizations would be to anticipate greater weekend activity, Patrick J. Hagan, MHSA, former president and chief operating officer of Seattle Children’s Hospital, wrote in an accompanying editorial.

“If patient elective activity is shifted to the weekend, the changes in staffing levels and skill mix suggested by Goodman and colleagues can be achieved not by adding staff, but through the redeployment of staff to support the shift,” Hagan wrote. “Admittedly, this approach would take time and effort and would have as its biggest challenge the cultural desire of all concerned for the weekend off. However, leveling demand to a consistent daily level within a narrow range of variation is not only possible, it is desirable — it would result in a future reduction in capital costs as we reduce the peak needs for everything from operating rooms to beds to parking capacity; a current reduction in operating costs as we stabilize staffing levels throughout the week; and the chance of improving patient outcomes as we reduce the variation created by the current difference between weekday and weekend hospital operations.”

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Disclosure: One researcher reports research funding from Pfizer for purposes unrelated to this study.