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Quality assessment of weekend discharge: a systematic review and meta-analysis.

PURPOSE
Hospital bed utility and length of stay affect the health care budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the "weekend effect". However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department (ED) visits and 14-day follow up visits compared with weekday discharges.


DATA SOURCES
PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched from January 2000 to November 2019.


STUDY SELECTION
PRISMA guidelines were followed. Only studies published in English were reviewed. The random effects model was applied to assess the effects of heterogeneity among the selected studies.


DATA EXTRACTION
None.


RESULTS OF DATA SYNTHESIS
There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the United States, including studies with high heterogeneity.


CONCLUSION
In the United States, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any health care inequality within the health care system and to improve the quality of patient care.