Monday, 25 April 2016

Hospital wards (2): occupation, weekends and safety

In the last Monday’s post, I was referring to the organizational quality, the provision for the medical guard and the coordination of professionals with the clinical safety of patients, and this second part of the same subject of hospitalization wards, I was left with a couple of things to deal with, also related to the quality of care: the stress caused by the large workload and the lack of services during the weekends.

The high occupancy of the wards increases mortality

A group from the University of Cologne, with the collaboration of Cambridge, has conducted a study in 83 German hospitals with more than 80,000 patients with pathologies of risk and have concluded that the tipping point for a hospital ward is 92,5%, occupation, a figure from which, the chaos inherent in the situation created by the excess patients, generates a significant increase in mortality.

"If a hospital regularly works above the tipping point, says professor Stefan Scholte's in the Cambridge University blog, you can bet that it has a structural quality problem, but what we need to be wary of, is those hospitals reaching the tipping point occasionally but repeatedly, generating risk situations for patients who are not normally detected by the aggregate statistics."

Inpatient wards are less secure at the weekends

Experts from Imperial College London and the colleagues of "Dr. Foster Intelligence" were warning, long time ago, that worse care and less clinical safety is observed during the weekends in the units of the British hospitals. As you can see in the next chart, more than two thirds of British doctors believe that things are like that, and in the chart below, the data are conclusive: increased mortality, fewer diagnostic services, more surgical waiting lists and more readmissions in the patients treated over the weekend.

The above data is extracted from the company website but in a more specific study published in BMJ, the conclusion is that for patients undergoing an intervention on a scheduled basis, the probability of death is 44% higher if the procedure is performed on a Friday and up to 82% if it is on a Saturday or Sunday.

The number of beds and the model for hospital guards are structural aspects that each country manages as it can. Despite this, and given the evidence, we should not sit idly by, so I propose two new clinical safety alerts: a) when an inpatient ward regularly reaches 92.5% occupancy should not admit any more patients, and therefore should implement, proactively, circuits of bypass to other wards or other hospitals, and b) risk interventions should not be scheduled Fridays or at the weekends.

Jordi Varela

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