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Hospital "Weekend Effect": Bad Outcomes for AF and Stroke Patients

Posted Jul 17 2012 12:00am

Late June and July are not favorable times to be admitted to the hospital. Some of the house officers are still quite green and even the more experienced among them may be new to the hospital and not know all of the local routines. There is also some irony in the fact that the new regulations restricting house officer work hours, designed to protect patients, may be having a negative effect by disrupting continuity of care (see:  Duty-Hour Restrictions For Surgical Interns Causing Concern ). It had not occurred to me before but there is also a risk involved with weekend hospital admissions (see: Weekend hospital visits more deadly, more expensive, and result in longer stays ). Below is an excerpt from an article on this topic:

Previous studies have identified a “weekend effect” in terms of a poor outcome for patients hospitalized with various acute medical conditions.  The aim of our study was to investigate whether weekend admissions for atrial fibrillation (AF) result in worse outcomes than those admitted on weekdays. In the Nationwide Inpatient Sample 2008 database, we identified a total of 86,497 discharges with a primary discharge diagnosis of AF.  The use of a cardioversion procedure for AF on weekends was lower than that on a weekday....After adjusting for patient and hospital characteristics and disease severity, the adjusted in-hospital mortality odds were greater for weekend admissions.... The length of stay was significantly longer for weekend admissions.  In conclusion, patients admitted with AF on weekends had lower odds of undergoing a cardioversion procedure and greater odds of dying.  

It turns out that a "weekend effect" has also been observed for stroke patients (see: High cost of ‘weekend effect’ in stroke care ). Below is an excerpt from this latter article:

Weekend admission affected two measures of quality care [for 93,621 stroke patients in England], reducing the proportion of brain scans undertaken within 24 hours to 42.6%, down from 47.8% during the week, and reducing thrombolysis use to 2.2%, down from 2.7%. These values were adjusted for variables including age, gender, comorbidities, and stroke subtype.  Patients were more likely to develop a complication - aspiration pneumonia - if they were admitted at the weekend, rather than during the week, at 5.6% versus 5.1%. As in previous research, 7-day in-hospital mortality was significantly higher if patients were admitted at the weekend, at 10.3% versus 9.0% for weekday admissions.

So what steps should you take to guard against this "weekend effect" for yourself and family members? Clearly you can't schedule a day for your atrial fibrillation or stroke. If you are being treated by a private physician, he or she needs to be alerted immediately when you are admitted to the hospital on an emergency basis. I have similar advice if you are admitted to a teaching hospital. Get some attention for your case beyond the reduced staff that may be working on the weekend. Another possible solution is to ensure that you are transported to a larger hospital for acute care (see: Weekend Effect Persists ). Here's an excerpt from an article written about after-hours quality from the perspective of a hospitalist:

For hospitalists trying to address the underlying problems of after-hours quality, the size of the hospital is relevant. Only larger hospitals can afford hospitalist groups large enough to cover night and weekend shifts. For those that can, are all members of the group taking their turns at night, does this duty fall to the junior members, or is the group lucky enough to employ nocturnists who want to work at night....Whether the hospital has an academic emphasis also can influence who responds to crises after hours—attendings or house staff (in other words, sleep-deprived residents).

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