Issue link: https://beckershealthcare.uberflip.com/i/549045
64 Chuck Lauer W hen I drop by a hospital on a week- end, I oen see fewer cars in the em- ployee parking lot than on a weekday. is is called "the weekend effect," which is a well- documented problem. Simply put, there are fewer physicians and nurses to treat patients, and fewer technicians to operate life- saving equipment on the weekend. However, people don't have fewer medical problems on the weekend. ey still have heart attacks, accidents and other emergencies, and there are plenty of patients admit- ted for elective procedures over the weekend. So it doesn't surprise me that there's a markedly higher death rate for patients admitted on the weekend — not just in the United States but in other countries as well. A study in the July 6 issue of BMJ Quality & Safe- ty looked at hospitals in the United States, United Kingdom, Australia and the Netherlands. It con- cluded that the odds of dying within 30 days of elective surgery were "significantly high" when it took place on the weekend, and "crude mortality" rates for weekend emergency admissions were higher in each location except Australia. e authors of this study suggested that the high- er death rate might be "specific to those diagnoses and procedures that are particularly sensitive to hospital services being reduced/absent on Satur- days and Sundays." at is, some of those missing cars in the parking lot may be those of technicians who operate some diagnostic equipment or life- saving devices. Robert Glatter, MD, an emergency physician writing about this study in Forbes, suggested that the lack of services might include "treatment and management of cardiac arrhythmias, pulmonary emboli and heart attacks, as well as diagnosing rare conditions such as aortic dissection." Also, there might be a problem with the caliber of personnel who will see you. e authors of the study speculated that "weekend patients may be subject to reduced and unsuitably skilled staff." at makes sense to me. As in any industry, the skilled people are allowed to choose when they can take time off, and of course they want to be off on the weekends. Dr. Glatter interviewed Al Sacchetti, MD, an emergency physician in New Jersey, who said that residents and fellows account for most weekend coverage in academic medical centers and some community hospitals. "Junior housestaff may not only lack the clinical experience to make medi- cal decisions," he said, "but also may not have the necessary clout to demand immediate diagnostic studies or access to the operating room or other specialized areas when needed." In an industry like healthcare, where you are deal- ing with life and death issues, is it permissible to reduce the availability of services and use second- string staffing for two days of every week? ink about it — weekends amount to about one-third of the time hospitals are open! e same phenomenon probably takes place dur- ing holidays like Christmas and anksgiving, and maybe even during the summer months, when some prominent doctors and nurses with seniority take their vacations. e BMJ Quality & Safety study is not the only one to find unacceptably higher quality problems on the weekend. In a study that BMJ published in April, a researcher at the Yale School of Medicine found that even though there were fewer admis- sions on the weekends, hospital-acquired compli- cations occurred at a higher rate — 5.7 percent, as compared to 3.7 percent on weekdays. And that's not the only study. In a 2012 study in the Journal of Surgical Research, Johns Hopkins research- ers found older adults with substantial head trauma were significantly more likely to die from their inju- ries over the weekend than during weekdays. "ere isn't a medical reason for worse results on weekends," one of the researchers for this study said in a release from Johns Hopkins. "It's more likely a difference in how hospitals operate over the weekend as opposed to during the week." Holly S. Andersen, MD, a cardiologist NewY- ork-Presbyterian Hospital, told Dr. Glatter that patients hospitalized on the weekend also have a longer length of stay. "e time has come to determine the cause, rather than again prove its existence," she said. I couldn't agree more. e need to deal with these quality issues is all the more urgent at a time when hospitals are being penalized for 30-day readmis- sions and are involved in accountable care organi- zations that aim for higher quality of care. ere are ways of counteracting the weekend effect, short of canceling weekend leave for senior hospital personnel. ese methods were outlined in a recent study presented at the American Surgical Associa- tion meeting in April by statisticians at Loyola Uni- versity Health System outside of Chicago. Examining policies at 117 Florida hospitals and their outcomes for 126,666 patients, researchers concluded that by boosting specific services, hos- pitals could lower the rate of complications on the weekend. ese strategies involved raising the nurse-to- bed ratio, fully adopting EHRs and improving inpatient physical rehabilitation, home health and pain management. Interestingly, simply hiring more staff — increas- ing the nurse-to-bed ratio — was not the most effective of these strategies. While hospitals that raised the nurse-to-bed ratio were 1.44 times more likely to overcome the weekend effect, the likelihood rose to 2.37 times for hospitals that had home health programs and 4.74 times for hospi- tals that fully adopted EHR. I can understand the link between high-quality EHRs and better performance. A new shi com- ing in on the weekend needs to consult the pa- tient's medical record as well as other sources. e weekend effect has already been clearly docu- mented in many studies finding higher rates of deaths and complications, and there are now spe- cific strategies available to hospitals to counteract this deadly phenomenon. Is anything being done about it? n How Are You Combating the 'Weekend Effect?' By Chuck Lauer, Former Publisher of Modern Healthcare and an Author, Public Speaker and Career Coach "In an industry like healthcare, where you are dealing with life and death issues, is it permissible to reduce the availability of services and use second-string staffing for two days of every week?"