Ten years ago, researchers found a link between weekend or weeknight hospital care and low survival rates for cardiac arrest. The good news is, quality of care has since improved. The bad news: It’s done nothing to increase patients’ chances of surviving an off-hour hospital stay.
This finding came from a new study published this month, which confirmed that the so-called “weekend effect,” a disparity between weekday and weekend hospital deaths, is still claiming more lives than during weekdays despite advances in treatment. The reasons for this anomaly, however, are difficult to identify.
Study Answers One Question, Raises Several More
The study looked specifically at in-hospital cardiac arrests of 151,000 patients between 2000 and 2014, comparing patients’ survival rates at different times heart attacks occurred. The hope was to find fewer deaths over time.
“We know that survival trends have improved in past decade or so,” said Dr. Uchenna Ofoma, assistant professor of medicine at Temple University and study lead. “The question now becomes ... what happens to the disparities? Has it remained the same? Is it narrowing?”
During the 14-year period, weekday survival rose from 16 to 25.2 percent; weekend and weeknight survival from 11.9 to 21.9 percent. In other words, while survival rates increased across the board, the gap between weekday and off-hours survival remained parallel, and off-hour survival much lower.
“We’re able to point out that the problem exists without really having great insight as to why,” said Dr. Seth Goldstein, a pediatric surgical fellow at Johns Hopkins Hospital who conducted similar research involving young patients. He found that children admitted to hospital for urgent surgeries on weekend were at higher risks of complications spanning from blood transfusions to death.
Theories Point to Patients, Doctors, and Witnesses
Goldstein has taken educated guesses at why this could be, however. Patients admitted to hospital on nights and weekends – times when people are perhaps more likely to drink or injure themselves – may be in a particularly vulnerable state.
Dr. Ofoma agrees that these patients may have been sicker in the first place. He also noted cardiac arrests in hospitals will less likely be witnessed by bystanders. For patients who experience cardiac arrests outside of hospital, witnesses (especially those who can perform CPR or defibrillation) contribute largely to chances of survival.
But this begs the question: Why rely on the average citizen to notice a heart attack in a hospital? Where are the doctors?
How Hospitals Can Tackle the Survival Gap
Dr. Ofoma believes the best way to address the weekend effect is to look to hospitals with the smallest disparity for inspiration. But even those show an unnecessary pattern of unchecked heart attack deaths. Goldstein maintains that the root of the problem lies not in patient vulnerabilities, but in how hospitals are being run.
“It is more difficult in a hospital to get laboratory values, x-rays done, EKGs performed at night than it is during the day,” he said. Plus: “The number of patients that we’re responsible for at any one time is higher during the less desirable shifts.”
These are the shifts that are commonly understaffed. On-duty doctors, then, are more likely to be overworked, unresponsive, and display other warning signs that lead to mistakes. Medical malpractice due to doctor negligence has been known to result from miscommunication with colleagues and failing to notice when patients take a turn for the worst.
The day of the week a patient is admitted into hospital isn’t necessarily indicative of medical malpractice, of course. But this trend, which has relented for years, is certainly something to be mindful of.