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How would you answer this question?
Your patient, Ms. Wald is admitted for severe sepsis and acute renal failure. As her nurse you know that her mortality will be increased by which of the following?
a. Hemodialysis
b. Fluid volume management
c. Weekend admission
d. Diagnostic testing
The correct answer is "c" weekend admission.
Patients admitted for acute renal failure on the weekend are 22% more likely to die within the first 72 hours of admission than are patients admitted during the week. The increased mortality was especially pronounced at smaller community hospitals (35% increase vs. 24% increase) compared to large teaching hospitals.
There are numerous theories on why mortality increases on the weekend. These include: 1) decreased availability of specialty physicians, 2) delays in diagnostic testing, 3) delays in invasive therapy, and 4) fewer nursing staff and nursing resources.
Other studies have identified higher mortality rates with acute myocardial infarction, stroke, pulmonary embolism, ruptured aortic aneurysm, GI bleeds, and ICU admission on weekends too. Whatever the cause it is important that nurses know that patients admitted on the weekend are more likely to die and to be vigilant about securing the resources necessary for their care. Managers would be wise to consider higher than usual staffing levels for the weekend to assure adequate nursing contact to assess for problems and avoid complications that can lead to patient death.
From:
Horwich, T.B., et al. (2009). Weekend hospital admission and discharge for heart failure: Association with quality of care and clinical outcomes. American Heart Journal, 158(3): 451-458.
James, M.T., et al. (2010). Weekend hospital admission, acute kidney injury, and mortality. JASN, published online ahead of publication: doi: 10.1681/ASN.2009070682.
Shaheen, AAM et al. (2009). Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol. Mar; 7:303.
Congratulations to Allison Brown who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Allison!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
PS. 10 Goals by 10/10/10! Find out how a professional coach can help.
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