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. 2014 Oct;26(5):530-7.
doi: 10.1093/intqhc/mzu065. Epub 2014 Jul 3.

Association of weekend continuity of care with hospital length of stay

Saul Blecker  1 , Daniel Shine  2 , Naeun Park  3 , Keith Goldfeld  3 , R Scott Braithwaite  1 , Martha J Radford  2 , Marc N Gourevitch  3
Affiliations

Association of weekend continuity of care with hospital length of stay

Saul Blecker et al. Int J Qual Health Care. 2014 Oct.

Abstract

Objective: The purpose of this study was to evaluate the association of physician continuity of care with length of stay, likelihood of weekend discharge, in-hospital mortality and 30-day readmission.

Design: A cohort study of hospitalized medical patients. The primary exposure was the weekend usual provider continuity (UPC) over the initial weekend of care. This metric was adapted from an outpatient continuity of care index. Regression models were developed to determine the association between UPC and outcomes.

Setting: An academic medical center.

Main outcome measure: Length of stay which was calculated as the number of days from the first Saturday of the hospitalization to the day of discharge.

Results: Of the 3391 patients included in this study, the prevalence of low, moderate and high UPC for the initial weekend of hospitalization was 58.7, 22.3 and 19.1%, respectively. When compared with low continuity of care, both moderate and high continuity of care were associated with reduced length of stay, with adjusted rate ratios of 0.92 (95% CI 0.86-1.00) and 0.64 (95% CI 0.53-0.76), respectively. High continuity of care was associated with likelihood of weekend discharge (adjusted odds ratio 2.84, 95% CI 2.11-3.83) but was not significantly associated with mortality (adjusted odds ratio 0.72, 95% CI 0.29-1.80) or readmission (adjusted odds ratio 0.88, 95% CI 0.68-1.14) when compared with low continuity of care.

Conclusions: Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend cross-coverage and patient handoffs may be useful to improve clinical outcomes.

Keywords: continuity of care; hospital; length of stay.

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Figures

Figure 1
Figure 1
Distribution of UPC for 3391 hospitalizations, 2011–12. The distribution reflects the UPC index for the first weekend of hospitalization.
See this image and copyright information in PMC

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