There’s new evidence of the “weekend effect and it’s worth examining a phenomenon of why patients don’t want to get sick on a Saturday: The increased chance they’ll face complications.
New research published this week from a Johns Hopkins Children’s Center team found simple emergency surgeries can be deadlier for kids on the weekends, raising questions about after-hours safety lapses and clinical glitches. The study further bolsters research from Johns Hopkins finding an increased risk for adult patients treated for heart attacks, strokes, an aneurism or head trauma during the weekend.
“These are provocative findings and, we hope, a conversation starter,” Dr. Seth Goldstein, a pediatric surgery resident at Johns Hopkins and lead author of the study published in the Journal of Pediatric Surgery, said in a statement. “Our next step is to understand the what, how and why behind this alarming disparity.”
We’re not talking huge numbers here. In looking at 22 years worth of surgery data from 440,000 pediatric admissions, the researchers attributed 30 deaths to the weekend effect, calling them extremely rare. Still, it was a statistically marked increase from weekdays. The data showed kids who underwent emergency procedures on weekends were 63 percent more likely to die than those treated during the week and 40 percent more likely to suffer complications.
Possible reasons? Researchers wonder whether decreased weekend staffing, slower response times and less availability of certain imaging and lab tests may be factors.
At George Washington University Hospital, Dr. Robert Shesser is skeptical. GW typically sees about 15 percent fewer patients during the weekends and has core specialty areas staffed the same way, no matter what day it is.
“It’s the same. It’s the same doctors, the same nurses. Everyone’s there,” said Shesser, the chairman of the emergency department.
If anything, said Dr. Anthony Sandler, operating rooms are less chaotic and more controlled on weekends because of fewer scheduled surgeries.
“Particularly at teaching hospitals, you have some depth from the bench,” said Sandler, senior vice president of Children’s National Medical Center’s surgical care center.
The study mentions the phenomenon isn’t as likely at academic institutions. “All hospitals do have reduced staffing on weekend, but if we’re talking purely from a surgical sense, we can’t even start surgery until a faculty surgeon is there.”
That’s not to say there might not be some important lessons for hospitals to consider, Sandler added.
He wondered if there is a delay in transferring some patients to a hospital that performs the surgery they need. Or perhaps some non-teaching hospitals aren’t able to maintain enough staffing for peripheral services which support surgery. Also, a high number of patients in the study were uninsured. Perhaps they were waiting and getting in worse shape before seeking care, he said.
“Where there’s smoke, there could be fire. In any profession when there are off hours, services may be less intensive,” Sandler said. “But I hate to believe that is true because that frustrates all the the systems we have in place.”