Wednesday, March 10, 2010

Hospitals and weekends don’t mix

hospital_cartoon An interesting piece on BNET today from Ken Terry.  Click here for the full article.  Here are some snippets (with commentary below):

Patients admitted to the hospital on weekends are 30 percent more likely to die there than those who arrive on weekdays. And guess why? It turns out that most doctors are reluctant to work irregular hours, which in turn delays care for weekend patients.

According to a new study from the Agency for Healthcare Research and Quality (AHRQ), delays in treating conditions such as heart attacks, angina, gall bladder problems and complicated hernias were much more common for patients admitted on weekends than for those hospitalized during the week. Just 36 percent of weekend-admitted patients received major procedures on the day of admission, versus 65 percent of those admitted on weekdays.

Of the 19 percent of all hospitalized patients who were admitted on the weekend, 2.4 percent died during their stay. In contrast, only 1.8 percent of patients admitted on weekdays died in the hospital. To some extent, this reflects the fact that far more patients admitted on weekends (65 percent) than on weekdays (44 percent) came in as emergency cases, rather than scheduled admissions.

But both sets of patients had similar characteristics, and their average lengths of stay and costs per admission were close. So the higher number of emergency cases on weekends does not fully explain the higher mortality rate among those patients. Moreover, emergency cases usually require more prompt attention than patients who come in for elective procedures. Delays in providing treatment may “be an indicator of [low] quality of care,” the researchers said.

In an organized system of care, an adequate supply of physicians would be available to care for acutely ill patients every day of the week. But in the U.S., specialists and surgeons routinely refuse to be on call at the hospital unless they’re paid extra. If they don’t have an inpatient procedure scheduled, they’d rather be seeing patients at the office or operating on them in ambulatory surgery centers. And on weekends, they’d rather be home. So the hospitals pay them to come in.

Making matters worse, many patients are only in the ER in the first place because they have no access to their regular physicians. In the U.S. and Canada, three of five doctors have no after-hours arrangements, according to an international study by the Commonwealth Fund. Not surprisingly, U.S. and Canadian patients also have the highest use of the ER for care that could have been provided by their regular doctor.

I know what you’re thinking: it’s a selection issue with sicker patients coming in via ERs on a weekend than the full and diverse population who come in for a variety of reasons during the week, including scheduled, non-emergent procedures.  Ken Terry does a nice job, however, debunking this.

Focusing on weekend and off hour coverage is a critical issue in home care as well.  The VNA of Boston has done so by providing excellent options for the home-based patient population, whether through our certified home health offerings, hospice programs or private care affiliate.  Click here for more information.

Image courtesy of CFB Borden.

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