The weekend effect. It may sound like something that happens after a busy weekend of partying, or after drinking a little too much. Maybe it sounds like an excuse for being especially lazy on weekends. But in actuality, it is a sad and sometimes puzzling statistic that has to do with patient deaths in hospitals.
What is the Weekend Effect?
The weekend effect is the name for the increased death rate of hospital patients based on the day of the week they are admitted. Studies have found that patients who are admitted to hospitals on weekends have a much higher rate of dying than those admitted during the week. There is also a reduced survival rate for patients admitted after hours, although that gap is not as noticeable as the weekend gap.
Using Wednesdays as a benchmark, one study found that people admitted on Saturday and Sunday had 11% and 16% higher mortality rates, respectively.
At first it was thought that the increased mortality rate was largely for those suffering heart attack and strokes, but now studies have shown that those admitted with head trauma are also at greater risk. Even children who are admitted for urgent although routinely performed surgeries had a higher rate of death, or at least, significant complications on the weekends.
Although patient care has improved, a January 2018 study focusing on cardiac arrest patients found that the disparity in death rates still exists. The survival rate for weekend admissions of patients with cardiac issues currently stands at 21.9%, with weekday admissions standing at 25.2%. These are improvements for the weekend numbers compared to previous studies, but there was no improvement in the disparity of death rates between on and off hours admissions.
Theories on the Difference in Mortality Rates
There are many theories why the rate of death increases for patients admitted on the weekend. Some speculate that hospital staff may be decreased, outside specialists may not be available, and there may be delays in having diagnostic testing done and interpreted. All of these result in the loss of precious time to treat emergency patients.
Time is a big deal, especially with cardiac patients. A large predictor of survivability is whether someone else is there to witness and respond to the cardiac event. On weekends, understaffed hospitals are less likely to have staff members present when a cardiac event happens.
Others say that the staff on weekends tends to be less experienced, the more experienced staff having the privilege of taking weekends off. Younger, less experienced medical providers may be less likely to have families, and thus are more available for weekend hours.
Nighttime hospital staff may suffer simply from fatigue after a long day. Physical exhaustion may result in a decreased ability to perform skilled activities, such as resuscitation.
It may also relate to the time and attention medical staff provides to patients. A specialist called in from her family dinner on Saturday night may be more prone to a quick, cursory evaluation of a patient then one who is seeing that same patient in the middle of a Tuesday afternoon workday.
Some theories point to the patients themselves, noting that weekend patients are admitted with more serious conditions. They are more likely to be victims of car accidents, sporting accidents, boating accidents, drug overdoses, or other activities more common on weekends.
Some Medical Areas do Not Have the Weekend Effect
One way to find the cause of the Weekend Effect is to look at the medical areas that do not see increased mortality rates on weekends. Areas like trauma surgery or transplant surgery also support these theories. These medical teams are generally used to operating around the clock, with immediate access to medical services.
Facilities such as Trauma 1 centers, where some specialists are available 24 hours, do not bear out the same Weekend Effect statistics, leading many to wonder why all hospitals are not more equipped to provide that kind of around the clock service to every patient.
Malpractice by Omission
These statistics are a reminder of the many forms of medical malpractice. It is easy to think of malpractice as an active act. For example, a botched surgery, or misdiagnosing something, or doing what we consider a “bad” job during a procedure. Malpractice cases are full of examples where routine medical procedures ended up in horrific injury when they should not have.
Often, malpractice comes in a more hidden form – when nothing at all happens. Sometimes this is called a failure to diagnose, or a failure to treat, or a delay in treatment. Improperly doing nothing or waiting too long to do something–“malpractice by omission”–can take any number of forms, but there are examples that do occur frequently.
A doctor may actively treat the wrong condition, leaving the actual condition undiagnosed and untreated. In understaffed hospitals, patient complaints may be written off as just whining, when in fact, the complaints indicate a serious and emergency condition that hospital staff fails to recognize. Patients may be left too long without a nurse visiting their room, or taking vitals.
In these cases, the operative question in a malpractice cases is the hypothetical “what if.” What if treatment was rendered in timely fashion, or a complaint of pain was immediately tended to, or a diagnostic test was given immediately? Would the patient have lived, or at least, recovered?
These are questions that get asked when patients suffer due to hospitals that do not have enough staff, or when response to medical conditions is slow or lacking entirely.
Whatever the cause of the so-called weekend effect, a delay in treatment when it is needed is never acceptable. Patients who suffer adverse results in hospitals should always ask whether they could have or should have been treated faster or more thoroughly than they were.
Medical malpractice can take many forms, and you may not even recognize malpractice at first. Call Brill & Rinaldi for a free consultation to discuss damages that may be available if you are a victim of medical malpractice.