Pediatric Leukemia Patients Admitted On Weekends At Greater Risk Of Adverse Outcomes

MedicalResearch.com Interview with:
Elizabeth Goodman BA
Division of Oncology
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania

Medical Research: What are the main findings of the study?

Answer: Weekend hospital admission for pediatric patients newly diagnosed with leukemia was associated with a longer length of stay, slightly longer wait to start chemotherapy and higher risk for respiratory failure; however, weekend admissions were not linked to an increased risk for death.

Medical Research: Were any of the findings unexpected?

Answer: Unlike previous research that has shown an increased risk of death in adults with leukemia whose first admission occurs on a weekend, children with leukemia fortunately do not have an increased risk of death with weekend first admission. While this improvement in mortality risk for children with leukemia admitted on the weekend was unexpected, these children were still at risk for other adverse outcomes such as increased length of stay and higher risk of respiratory failure.

Medical Research: What should clinicians and patients take away from your report?

Answer: Clinicians should be aware of the increased risk of adverse outcomes, such as increased risk of respiratory failure, for children with leukemia admitted on the weekends. Potential causes of this variation include patient level factors, such as increased patient acuity in weekend admissions, and hospital level factors, such as decreased weekend hospital staffing levels and availability of diagnostic and therapeutic resources. Given that additional research is necessary to determine the cause of these adverse outcomes, clinicians should be especially vigilant and proactive with these patients to ensure that these patients receive appropriate diagnostic and therapeutic care despite weekend admission.

Medical Research: What recommendations do you have for future research as a result of this study?

Answer: The underlying etiology of this increased risk of adverse outcomes in children with leukemia admitted on weekends has yet to be determined. Potential explanations include both patient and hospital level factors. This study found that high-acuity patients represent a greater proportion of overall admissions on the weekend, contributing to the observed adverse outcomes. Possible causes that merit further study include delayed referral from primary care physicians and delay in parents bringing their children to medical attention due to socioeconomic constraints, such as inability to leave work. Additional research is also needed to determine whether hospital level factors, such as staff number and skill mix, physician cross coverage, and weekend availability of diagnostic and therapeutic resources contribute to this problem. Systematic assessment of weekend and weekday staffing levels and diagnostic services by hospitals is an important initial step hospitals can take to begin to identify areas with insufficient weekend resources. Increasing the availability of weekend resources may lead to increased hospital expenditures, thus, additional research to determine the most clinically and cost-effective allocation of weekend resources is necessary.

Citation:

Goodman EK, Reilly AF, Fisher BT, et al. Association of Weekend Admission With Hospital Length of Stay, Time to Chemotherapy, and Risk for Respiratory Failure in Pediatric Patients With Newly Diagnosed Leukemia at Freestanding US Children’s Hospitals. JAMA Pediatr. Published online August 25, 2014. doi:10.1001/jamapediatrics.2014.1023.