Monday, 13 February 2017

The weekend effect on hospitals

A meta-analysis of 48 studies and nearly 2 million hospitalizations for acute myocardial infarction has concluded that, during the weekends, waiting time for the start of angioplasty is on average of minutes longer, while mortality at 30 days is also, on average, 6% higher, a deviation that can reach 12% if high ST segment infarctions, which are susceptible to angioplasty, are also taken into account. A North American study of nearly one million hospitalizations for acute renal failure found that patients admitted on weekends had, on average, a probability of dying 7% higher, and in another study, also with extensive databases, on scheduled surgery in English hospitals, concluded that patients operated on Friday had a 44% higher probability of dying, a figure that rose to 82% if the intervention was performed on Saturday or Sunday (see an earlier post on the subject in this same blog). The three studies cited are just a sample of the harsh reality of the phenomenon. Just perform quick search on the scientific search engines to extract, for example, three more studies that go along the same lines (Bell 2001, Freemantle 2012, Perez Concha 2014). I have even found a study that has observed a higher mortality in urgent paediatric surgery (Goldstein 2014).

What happens on weekends in hospitals?

All these studies record minutes, but they’re not as good at determining the causes of the poor results observed on Saturdays and Sundays, because, although robust, they are based on retrospective methodologies. Now, if we leave aside the analysis, and take a look at the hospitals during the weekends, what do we see? Well, you do not have to be an expert to realize that the professional teams are smaller and, often, the technical ability of some on-guard teams is quite frankly in great need of improvement.

Dr. Perri Klass, a paediatrician and writer, in an article, "Death Takes a Weekend," published in the New England says: "When you are accompanying an ill person and the weekend arrives, you realize that the hospital is not designed for patients. You notice that it’s an organization of doctors, nurses, physiotherapists, nutritionists, etc., all very busy people resolving the work issues as they can. However, most of them don’t realize that the hospitalised patients are far from having a normal life."

Sadly, it doesn’t appear that, in the short or medium term, hospitals will be able to offer services of comparable quality seven days a week, but this means that, considering the persistence of the results, specific plans ought to be drawn up for the improvement of care quality at weekends, so I suggest three lines of work: a) specific training to improve the professional level for rotating teams, b) efficacy review for the clinical circuits that are susceptible to rapid action, and c) analysis of occurred errors to promote essential adjustments.

Jordi Varela

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