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BackgroundWeekend admission to the hospital has been found to be associated with higher in-hospital mortality rates, but the cause for this phenomenon remains controversial. US based studies have been limited in their characterization of the weekend patient population, making it difficult to draw conclusions about the implications of this effect.MethodsA retrospective cohort study, examining de-identified, patient level data from 2015 to 2017 at US academic medical centers submitting data to the Vizient database, comparing demographic and clinical risk profiles, as well as mortality, cost and length of stay, between weekend and weekday patient populations. Between-group differences in mortality were assessed using the chi-square test for categorical measures and Wilcoxon rank-sum test for continuous measures. Logistic regression models were used to test the multivariate association of weekend admission and other patient-level factors with death, LOS, etc.ResultsWe analyzed 10,365,605 adult inpatient encounters. Within the weekend patient population, 30.6% of patients were categorized as having either a major or extreme risk of mortality on admission, as compared to 23.7% on weekdays (p p p ConclusionThe patient population admitted on weekends is proportionally higher risk than the population admitted on weekdays, and the observed weekend mortality effect is largely attributable to this risk imbalance.

Spiritual care can be an important source of support for patients dealing with chronic or terminal illnesses, and it is a key component of palliative care.1 Studies have shown that patients would like more frequent discussions on religion and spirituality (R/S) while in the hospital,2 3 but many patients do not have the chance to do so. One way to ensure that R/S is addressed during a hospital stay is via chaplain referrals. One study showed that chaplain visits are associated with increased patient satisfaction, and patients more often endorsed that staff met their emotional and spiritual needs,4 although research shows differences among professionals in chaplaincy referral rates; nurses have been shown to have higher likelihood of referring than physicians and social workers (SWs).5 With the advent of the electronic health record (EHR), we felt it was important to explore whether or not healthcare professionals (HCPs) are interested in technology for requesting chaplains, and therefore improve access to spiritual care for patients. In fact, some initial research shows potential benefits of using electronic means to better identify and target patients in need of a chaplain visit,6 and one innovative palliative care service using pagers for referrals was reported as highly valuable by nurses to patients and the clinical team.7 Here, we report results from a quality improvement (QI) project aimed at improving chaplaincy referrals, and therefore spiritual care, at a major academic centre in New York City, with a focus on gauging interest in …