Staffing Effects on Weekend Medical Care

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Appendectomies are appendectomies, right?  As long as you have trained professionals operating in a safe environment, it shouldn’t matter when your patients go under the knife. Except that sometimes, it does. A number of researchers suggest if your patients are having surgery, or coming into the ER with a heart attack on the weekend, they are more likely to suffer negative outcomes, including death. Evidence points to a concerning “weekend effect” at hospitals: a small but meaningful increased risk of death associated with a hospital stay on a weekend versus a weekday.

One such study, published in the Journal of Pediatric Surgery (1), showed that children who underwent urgent emergency procedures on weekends were 63 percent more likely to die than those treated during the week. To be fair, the individual risk is miniscule, and the actual deaths attributable to the weekend effect were very few, just 30 over the 22 years. But if you are one of the 30…

Another study from Tufts University found significantly higher mortality rates in non-elective hospital admissions on the weekend across the United States over a five-year period. Earlier studies have shown the same results for a wide variety of conditions: strokes, heart attacks, patients needing cardiopulmonary resuscitation and other life-threatening emergencies involving weekend trips to emergency rooms.

Research suggests that patient factors may also play a role. For example, patients may wait longer before entering the hospital or seeking medical care on weekends, making them sicker or their cases more complex upon arrival. In addition, patients may have fewer family or friends available to support them on weekends, causing them to be more desperate before seeking medical assistance (2).

Possible organizational factors include decreased weekend hospital staffing, slower response times, and decreased availability of certain imaging and lab tests. Even when staffing numbers might actually be consistent, the most senior and experienced physicians, nurses, and support staff may have reached a point in their careers as to have weekends off, leaving less experienced staff on the floor.

For the first time, a new study (3) has identified five resources that can help hospitals overcome this "weekend effect":

• Hospitals that had an increased nurse-to-bed ratio were 1.44 times more likely to overcome the weekend effect. Hospitals with the best success rates had a median nurse-to-bed ratio of 1.1.
• Hospitals that had home health programs were more than twice as likely to overcome the weekend effect. In home health programs, there are skilled caregivers who check in on patients after they are discharged, and provide basic services such as providing wound care, administering medications, etc.
• Hospitals that had fully adopted electronic medical records were four times more likely to overcome the weekend effect.
• Hospitals that had inpatient physical rehabilitation programs were 1.03 times more likely to overcome the effect, as rehab programs identified patients who would require additional physical conditioning before or after discharge.
• Lastly, hospitals that had pain management programs were 1.48 times more likely to overcome the weekend effect.

Sources:

1. DOI: 10.1016/j.jpedsurg.2014.01.001
2. Marco J, Barba R, Plaza S, Losa JE, Canora J, Zapatero A. Analysis of the mortality of patients admitted to internal medicine wards over the weekend. Am J Med Qual. 2010;25(4):312–318.
3. "Components Of Hospital Perioperative Infrastructure Can Overcome The Weekend Effect In Urgent General Surgery Procedures." The complete manuscript of this study and its presentation at the American Surgical Association's 135th Annual Meeting, April 2015, in San Diego, California, is anticipated to be published in the Annals of Surgery pending editorial review.