Weekend Hospital Admissions: Do Patients Get Worse Care?
Two important studies were recently reported on in one of my clinical journals. Both examined weekend vs weekday admissions for upper GI bleeds and looked at the rates of mortality associated with both.
It was not surprising to me that mortality was higher in the weekend group despite the fact that hospital care should be the same regardless of the day of the week. This has been termed the “Weekend Effect”. Factors such as decreased staffing and speediness of diagnositic procedures were often delayed.
The delay in diagnositic testing, averaging 2.21 days, led to more surgeries to control bleeding, apparently as a result of delayed endoscopy. More surgeries in turn led to more post-op complications.
On a purely anecdotal level, I would wager that the seasonal variations may also negatively impact the quality of care. More vacations are taken in the summer and access to your particular specialist may not be available.
When my mother was recently hospitalized for a transient ischemic attack, (TIA), the cardiologist would not come in on the weekend to read her echocardiogram and clear her for discharge home. She had otherwise been cleared for discharge by her neurologist and hospitalist. Since she was not sleeping well in the hospital, had greatly improved, AND she had been cleared by 2 other specialists, we elected to discharge her “against medical advice” (AMA). Besides, I had flown down there to stay with her and felt totally comfortable handling the situation – but non-medical people likely would not. All of this would have driven up the cost of my mother’s stay for no benefit that I could see.
The take-home message is to make sure to advocate for your loved one’s access to care over the weekend.
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