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ORIGINAL ARTICLE
Year : 2013  |  Volume : 16  |  Issue : 4  |  Page : 501-504

Weekend versus weekday hospital deaths: Analysis of in-patient data in a Nigerian tertiary healthcare center


1 Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
2 Department of Family Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
3 Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
4 Department of Haematology, Chimex Specialist Hospital, Nnewi, Nigeria

Date of Acceptance15-Feb-2013
Date of Web Publication23-Aug-2013

Correspondence Address:
B O Nwosu
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe, University Teaching Hospital, Nnewi
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.116900

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   Abstract 

Aim: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria.
Materials and Methods: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals.
Results: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360).
Conclusion: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

Keywords: Hospital deaths, in-patients, weekend deaths


How to cite this article:
Nwosu B O, Eke N O, Obi-Nwosu A, Osakwe O J, Eke C O, Obi N P. Weekend versus weekday hospital deaths: Analysis of in-patient data in a Nigerian tertiary healthcare center. Niger J Clin Pract 2013;16:501-4

How to cite this URL:
Nwosu B O, Eke N O, Obi-Nwosu A, Osakwe O J, Eke C O, Obi N P. Weekend versus weekday hospital deaths: Analysis of in-patient data in a Nigerian tertiary healthcare center. Niger J Clin Pract [serial online] 2013 [cited 2018 Dec 19];16:501-4. Available from: http://www.njcponline.com/text.asp?2013/16/4/501/116900


   Introduction Top


The optimal source of information in the time of death in populations is vital registration data based on medical certificates of time and cause of death, issued by physicians. [1] Such information can also be obtained from the medical records of the hospitals. In Nigeria as well as in many developing countries, deaths are usually recorded mainly in the secondary and tertiary hospitals, hence information on deaths are not adequately reported.

Medical records of individuals who die in the hospital may not contain the actual time of death because in several cases, the time documented may be the time of certification of death by the physician. However, the discrepancy is not usually much and more so, the dates of death are usually recorded appropriately. [1]

Studies have revealed the peak time of hospital deaths to be after regular work hours and weekends. [2],[3],[4],[5],[6] Public holiday periods have also been implicated as a period of higher hospital death rates. [5] Poor communication between doctors, inadequate handovers at night and delays in contacting consultants have been implicated in some reviews to influence the rate of hospital deaths after regular work hours. [7] Highly critical report also exposed substandard decision making and a lack of involvement by senior clinical staff in the treatment of patients who died shortly after being admitted as causes of higher weekend death rates. [7]

In Nigeria, there is paucity of data on the time of hospital deaths and factors that may influence such. This study therefore aims at identifying the variations in the time of in-patient hospital deaths and the distribution of hospital death of patients over a 10 year period. The findings from this study on the prevailing time-specific mortality patterns would have important implications for current and future health priorities in Nigeria and in the monitoring and evaluation of health programs.


   Materials and Methods Top


This is a 10 year retrospective descriptive epidemiological study conducted at the Nnamdi Azikiwe University Teaching Hospital, Nnewi from January 1, 1998 to December 31, 2007. Nnewi is a semi-urban town and the second largest city in Anambra State, Southeastern Nigeria. Nnamdi Azikiwe University Teaching Hospital (NAUTH) is a 335-bed tertiary referral hospital that is conveniently located near the major business areas of Southeastern Nigeria. It has 23 clinical departments and provides services for both medical undergraduates and post-graduates and a referral center serving Anambra, Imo, Delta, Enugu, and Abia states, Nigeria. The death records of the hospital were accessed from the various wards and health records department to extract relevant data in the time of hospital death, as well as socio-demographic characteristics, year, and place of death. The time of death recorded is the time the in-patient was certified dead by the doctor on duty. The data obtained were analyzed using Epi info software (version 15.0) and represented in frequency tables and percentages. Tests of significance were done using Chi-square test at 95% confidence interval.


   Results Top


The results are presented in part in [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6] and [Table 7]. A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The predominant age group was that of 10 years and below, 893 (23.8%), followed by 41 to 50 years, 496 (13.2%). The least was age 90 years and above, 19 (0.5%). Of these patients, 2162 (55.0%) were males and 1772 (45.0%) females, giving a male to female ratio of 1.2:1. The highest number of deaths was recorded in the male medical ward, 1085 (27.6%), followed by the female medical ward, 858 (21.8%) and the special care baby unit, 688 (17.5%). The ward with the least number of mortalities recorded was the gynaecological ward which recorded 10 (0.3%) deaths during the study period. Deaths during weekends and weekdays in the wards followed a similar frequency pattern as the total deaths. The highest number of deaths was recorded in 2007; 881 (22.4%) followed by 2006; 579 (14.7%) while the least was recorded in 1998, 202 (5.1%). The same trend followed for the total number of weekend and weekday deaths.
Table 1: Age distribution of patients [N=3760]

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Table 2: Sex Distribution of patients

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Table 3: Distribution of patients by ward of admission

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Table 4: Distribution of patients by year of death

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Table 5: Average weekend and weekday death distribution by sex

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Table 6: Average weekend and weekday death distribution by ward of admission

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Table 7: Average weekend and weekday death distribution by year of death

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An average of 547 deaths were recorded for the weekend days each and 568 for the weekdays each over the study period. This gives a ratio of average weekend deaths to average weekday deaths of 0.96:1. This difference was not statistically significant (P > 0.05). There were more male and female deaths during the weekdays than the weekends, giving a ratio of weekend to weekday death of 0.99:1 and 0.93:1 for the males and females, respectively. These differences were not found to be statistically significant (P = 0.6734).

[Table 6] shows the average deaths of each ward for the weekends and weekdays. The average weekend deaths were more in the male medical ward, male surgical ward, intensive care unit, labor ward, and obstetrics ward. The labor ward, followed by the intensive care unit had the highest weekend to weekday death ratio of 1.72: 1 and 1.41:1, respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1.

[Table 7] shows the average weekend and weekday deaths per year. There was generally less average number of weekend to weekday deaths over the period, except in 2000 where there were more weekend deaths with a weekend to weekday average death ratio of 1.18:1.


   Discussion Top


The age range of the patient was from a few hours to 94 years, with a mean age of 38.5 ± 36.9 years. Inclusion of deaths from the newborn unit may account for the wide variation observed.

Generally, this study revealed less weekend to weekday deaths, with a ratio of average daily deaths in the weekends to weekdays of 0.96:1. This higher ratio of weekend to weekday deaths is in contradistinction with findings from other studies done in Europe and Australia. [1],[2],[3],[4],[5],[6],[7] This discrepancy may be due to difference in attitude and cultures of people in Africa, particularly in Nigeria when compared to Europe and Australia, especially with regards to time of hospital presentation and weekend hospital attendance. Over the period of study there was generally a higher average weekday deaths for each year, except 2000 and 2005, where there was a ratio of weekend to weekday deaths of 1.18:1 and 1:1, respectively. However, this slightly increased risk of weekday deaths in the years under study was not found to be statistically significant (P > 0.05).

The ratio of weekend to weekday deaths among the males and females was found to be 0.99:1 and 0.93:1, respectively. These differences were not found to be statistically significant (P = 0.6734). The average daily deaths in the labor ward was found to be significantly higher in the weekends than in the weekdays with weekend to weekday ratios of 1.72:1 (P = 0.0461). This finding however is in keeping with findings from surveys done in Australia, [2] where patients who were admitted during the weekends had 20% chance of death as opposed to weekdays that had 14%.

There was less average weekend to weekday deaths in the gynaecological ward, with a ratio of 0.63:1. This difference was however not statistically significant (P = 0.7360).


   Conclusion Top


This study has revealed a slightly increased risk of hospital deaths in the weekdays when compared to weekends over the years and for each sex. Also, these deaths were generally found not to vary significantly over the weekends and weekdays in the wards, except the labor ward which had significantly higher weekend death rates. Confidential enquiry of deaths in hospitals is recommended as it will help identify the actual causes of deaths, the factors influencing these death rates as well as proffer possible solutions.

 
   References Top

1.Pattaraarchachai J, Rao C, Polprasert W, Porapakkham Y, Pao-In W, Singwerathum N, et al. Cause- specific mortality patterns among hospital deaths in Thailand: validating routine death certification. Popul Health Metr 2010;8:12.  Back to cited text no. 1
    
2.Bhonagiri D, Pilcher DV, Bailey MJ. Increased mortality associated with after-hours and weekend admission to the intensive care unit: A retrospective analysis. Med J Aust 2011;194:287-92.  Back to cited text no. 2
[PUBMED]    
3.Freemantle N, Richardson M, Wood J, Ray D, Khosla S, Shahian D, et al. Weekend hospitalization and additional risk of death: An analysis of inpatient data. J R Soc Med 2012;105:1-11.  Back to cited text no. 3
    
4.UK hospital death rate higher for weekend admissions. In: Nursing Times. Net. Available from: http://www.nursingtimes.net/nursing-practice/clinical-specialisms/public- health/uk-hospital-death-rate-higher-for-weekend admissions/5041057.article. [Last accessed on 2012 Aug 29].  Back to cited text no. 4
    
5.Daily Mail Reporter. The wrong time to be ill: Hospital death risk rises 40% on bank holidays. Available from: http://www.dailymail.co.uk/news/article-1337335/The-wrong-time-ill- Hospital-death-risk-rises-40-cent-bank-holidays.html. [Last accessed on 2012 Sep 1].  Back to cited text no. 5
    
6.Hawkes N. Higher death rates among hospital patients admitted at weekends has several causes, report finds. BMJ 2011;343:d7791.  Back to cited text no. 6
[PUBMED]    
7.Poor handovers and working time directive ′causing hospital deaths′. The Guardian. Available from: http://www.guardian.co.uk/society/2009/nov/05/nhs-confidential-patient- care-study. [Last accessed on 2012 Aug 29].  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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