Why You Don’t Want to Get Sick on a Saturday
You’ve crashed your car on rural road at 2 a.m. on a rainy Saturday. Seriously injured and in pain, you are hauled into a noisy ambulance, then, because you’re so far from the nearest trauma center, into a waiting helicopter. You finally make it through the hospital doors just before 3 a.m. and are greeted by a team of able doctors and nurses wearing blue paper gowns and masks who descend on you like a swarm of bees. As you drift into a deep chemically induced sleep, you feel thankful that a well-organized, coordinated system was in place to save you in the middle of the night. And on a weekend, no less.
It turns out, however, that your confidence may not be so justified. For years, studies have shown that health outcomes — like recovery from heart attacks or procedures requiring time in intensive-care units — for patients who are rushed to emergency rooms at night or on weekends aren’t as good as for those who are treated during so-called working hours. But a recent study in the Archives of Surgery found that outcomes for injured patients in Pennsylvania are remarkably similar when comparing weekdays with weeknights, and that they are actually slightly better on weekends compared with weekdays. It was one of the first to demonstrate that for trauma, there is no “night-weekend effect” whatsoever, at least in Pennsylvania, which has a well-developed trauma system.
The reason for the effect is no mystery — smaller staffs with slightly less experience are more common during nonbusiness hours. On Monday afternoon, for example, hospitals are typically teeming with regular activities, so the add-on “emergency” heart attack can be squeezed in easily. But on Saturday night, there is a well-trained skeleton crew working the ER, but if coordination with other services is needed, groggy doctors summoned from home may have long drives to the hospital, delaying definitive treatment.
So why are trauma patients like the ones in the Pennsylvania study different? The answer is smart system design and strict standards on the treatment of trauma patients. Trauma systems are planned so that patients are taken or quickly transferred to hospitals that specialize in treating serious injuries. And there are explicit criteria for designating such centers as, for example, a Level 1 trauma center that can handle sick, injured patients.
In more common types of emergencies, like stroke, patients can experience a wider range of care, depending on the type of hospital in which they find themselves. A study published this week documented a weekend effect in stroke patients in New Jersey hospitals: the chances of dying within 90 days of the stroke was 17.2% for patients admitted on weekends vs. 16.5% for patients admitted on weekdays — a small but statistically significant difference. But that weekend effect was limited to hospitals that were not comprehensive stroke centers and therefore not able to deliver a full spectrum of care to stroke patients.
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