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Solving The Weekend Effect For Patients In The Hospital

Thu, 11/14/2013 - 9:24am
Robert Pearl, M.D.

If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick?

It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place you can be? Not always.

Patients hospitalized Friday night or over the weekend stay longer than patients admitted for the same problems Monday through Thursday. This adds unnecessary costs to their medical treatment. But the problem is more than financial. These patients also face a greater chance of experiencing a complication. And the extra day can even cost patients their lives. It’s a risk that most people don’t realize and most doctors don’t acknowledge.

Journal of the American Medical Association study found that hospitalized patients who suffered a cardiac arrest during nights and weekends were less likely to survive. A British study found that patients who were admitted to a hospital on a Sunday faced a 16 percent higher risk of dying within a month than those admitted on weekdays. And Canadian scientists found that ischemic stroke sufferers admitted to hospitals over the weekend were more likely to die within seven days than those admitted during the week.

The obvious question here is: Why? The answer is a complicated mix of economics and medical culture.

During the week, all diagnostic and interventional services are open. On the weekend, many of them shut down except when staff members are called in to care for a life-threatening problem. The on call staff understands that when a patient’s life depends on their expertise, they need to stop what they are doing and drive to the hospital. But the culture of medicine supposes that making a stable patient wait until Monday won’t be a problem.

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