A good weekend...only not for the patient!
October 9, 2014
Professor of Healthcare Management Nardo van der Meer read in the paper that there is a negative effect on survival when admitted into a hospital on the weekend, especially for seriously ill patients. This should be a thing of the past, he believes.
The Netherlands Cancer Institute recently published alarming research results: The risk of patients developing complications after a long operation is greater if the operation takes place on a Friday. On weekends, follow-up care is probably less effective, as a result of which complications are not readily observed.
As shocking as this may sound, it is not a new phenomenon. This phenomenon is known in the international medical literature as the “weekend effect”.
Quite a bit of research has been conducted into this and several studies have proven the weekend effect. In the category of “seriously ill patients” in particular, there is a negative effect on survival for patients with life-threatening conditions, such as a heart attack, when admitted into a hospital on the weekend. The reason? It turns out that the time between admission, diagnosis and receiving the right therapy is considerably longer on the weekend than on normal weekdays.
Matter of experience and risk assessment
With this in mind, my decisions as an intensivist are also influenced by the weekend effect. The intensive care unit is filled with vulnerable patients. Even if they are sufficiently recovered to be transferred to the regular nursing unit, I keep the day of week in mind. It is simply a matter of experience and risk assessment. Traditionally, there are fewer nurses and doctors working on the weekend. The total number of patients may be lower on weekends, but individually, they are sicker on average (otherwise they would not be in the hospital on the weekend). I have always preferred to keep vulnerable patients in intensive care on Friday, Saturday and Sunday because the Netherlands scores no better or worse in this area than other countries. In other words, we are also prone to the weekend effect.
As an intensivist, I find in safer to keep a certain category of vulnerable patients in intensive care during the weekend and then transfer them without worry on Monday or Tuesday. I’m not unique in this sense; I hear that lots of my colleagues do the same. It is actually quite unbelievable that, in the year 2014, we are unable to maintain the same level of safety for our patients throughout the entire week. And simply because it has always been that way! This should be a thing of the past, right?
Recognizing and acknowledging is half the battle
But what are we going to do about it? Recognizing and acknowledging the problem is half the battle! I challenge hospitals to identify their “weekend effect” and change this! The solution sometimes lies in more training, sometimes in more personnel or in different scheduling and logistics. Make the problem transparent to the entire staff and discuss a solution. Only then can we wish patients a “good weekend” with confidence.