When a patient is admitted to the hospital, a lot of bad things can happen and often do. Many studies have been done to try and identify those factors that increase the risk of an in-hospital death. Some of the factors which have been identified are ones over which we have little control. For example, males have a higher risk of death as do lower income individuals. Older age and the presence of co-morbidities are also factors which increase the likelihood of an in-hospital death and over which we have no control. Perhaps unsurprisingly, being admitted to the hospital on the weekend also increases the risk that you won’t survive the experience.
The phenomenon of increased risk of death for hospital admissions over the weekend is known as the “weekend effect” and is widely recognized. Depending on the study and the institution, the increased risk of death for weekend admissions is between 7% and 19%. While the risk of death is increased for both elective and non-elective admissions, the rate for non-elective admissions is significantly higher. This is due to the fact that elective admissions usually involve healthier patients than non-elective admissions. Patients are admitted on a non-elective basis for health emergencies, such as heart attacks or strokes, and for the results of accidents. But even among non-elective admissions, a patient has a better chance of surviving if admitted during the week.
A recent study of over 120 million hospital admissions during a three year period found that, after controlling for all other factors, the most likely explanation for higher rates of death for weekend admissions was lower staffing levels on the weekend and less-experienced personnel. Patients who were admitted on the weekend underwent fewer medical procedures during the first 24 hours than those admitted during the week. This finding supports the idea that lower staffing levels means that some procedures which might have been performed immediately during the week are delayed for weekend admissions. Another possible explanation is that lower staffing levels and lower experience levels resulted in fewer tests or procedures being ordered by those doing the treating on the weekend. Fewer procedures during the first 24 hours of an admission may be a major factor in explaining why these patients don’t survive the experience. Earlier testing and intervention may have saved some of them. Sadly, hospitals just don’t function as efficiently on the weekend as they do during the week.
We aren’t the only country in which it is risky to be admitted during the weekend. Studies from Canada, England and other European countries found the same troubling increased risk of in-hospital death.
If you experience a health emergency on the weekend or are the victim of an accident that requires hospitalization, you don’t have the luxury of waiting until everyone is back to work on Monday to go to the hospital. You go when you need to go. Just be aware that the medical staff you encounter may not be the best and the brightest that the hospital has to offer. While you should always be vigilant when in the hospital, be even more so on the weekends. Have an advocate with you, if possible, to ask questions and help make sure that what needs to be done gets done. Best of all, be careful and do your best to stay out of the hospital altogether.
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