Weekend Continuity of Care and Length of Stay

 In a 2014 study, researchers wanted to evaluate the association between attending physician continuity of care on weekends and clinical outcomes. They wanted to know — could increased length of stays be the result of delays in clinical decision-making, including diagnostic work-up and treatment, because of cross-coverage by weekend physicians?

Researchers looked at 3,391 patents at an academic medical center in the U.S. The data was derived from the hospital’s EHR system.

The questions is important because continuity of care is particularly relevant on weekends, where frequent cross-coverage may lead to adverse events. In general, weekends have been associated with reduced quality of care and poor outcomes, including in-hospital cardiac arrest and mortality, compared with weekdays.

The results of this study showed that increased attending physician continuity during the first weekend of hospitalization, which represented the only weekend of hospitalization for the majority of patients in the study, was associated with reduced length of stay.

When compared with low continuity of care, moderate continuity of care was associated with an 8% reduction in length of stay, while high continuity of care with a 36% reduction in length of stay.

Increased continuity of care was also associated with an increased likelihood of weekend discharge.

The researchers did not find an effect of continuity 30-day readmissions or mortality.

The researchers note that some degree of discontinuity of care is inevitable in a hospital setting. But they also noted that discontinuity of inpatient attending physician care was common on the weekends. To ensure that patients receive the best possible care on weekends, they suggested improved systems of cross-coverage was necessary, including new models of physician coverage.