AHRQ: Hospital Patients Less Likely To Get Necessary Care on Weekends

Cheryl Clark, March 4, 2010

Patients admitted to a hospital on a weekend are half as likely to get procedures they need on the same day they arrive than if they were admitted on a weekday, according to a federal report that officials says is the first of its kind.

The study also disclosed that 2.4% of patients admitted on the weekend died in the hospital, compared to 1.8% of patients admitted during the week.

But the study, from the Agency for Healthcare Research and Quality, did not draw any conclusions from the data about the quality of care provided on weekends versus weekdays in the nation's hospitals because the results were not adjusted for severity of illness.

"This report does raise the issue that there could be a 'weekend' effect, but that further study is needed," says P. Hannah Davis, lead author of the study. "We can't conclude that there is a weekend effect."

The higher mortality for patients admitted on the weekend could be because about 70% of the patients who went to the hospital on a Saturday or Sunday were admitted through the emergency department, compared with 40% of those admitted during the week.

The report showed that weekend patients were three times more likely to be there because of real emergencies, such as a heart attack, stomach bleeding, fractures or internal injuries than patients who came to the hospital on a weekday, Davis says.

The report, one in a series of statistical briefs from AHRQ's Healthcare Cost and Utilization Project, looked at a database of hospital inpatient stays throughout the country in 2007.

Of the 39.5 million stays in 2007, 7.7 million or 19% began on a Saturday or a Sunday. Only 11% of weekend admissions were elective, as opposed to 28% of weekday admissions.

The study did find that patients admitted on weekends tend to experience delays in receiving major procedures. For example, on the day of admission, weekend admitted patients received 36% of major procedures that they would receive during their stays, compared to 65% for patients admitted on weekdays.

"This delay may be related to the scheduled nature of weekday procedures, but may also be an indicator of quality of care," the report said.

Also, when looking just at patients with heart attacks, on the first day after admission, 64% of weekend admitted patients received major cardiac procedures, but 76% of patients admitted on a weekday got procedures by the first day. Also, 44% of weekend patients with gastrointestinal bleeds received an endoscopy, compared with 58% of patients admitted on a weekday.

The report may raise some questions about the reasons for delay in care, but Davis says those issues may be addressed by subsequent research by AHRQ or others. Did hospitals' ability to conduct necessary procedures differ between small versus larger facilities? Or between urban versus rural hospitals, where surgical specialists may have to travel farther or be in shorter supply?

Another question left unanswered is whether emergency room physicians and staff may have been less able to promptly diagnose patients admitted on the weekend because of lack of access to medical records, a problem that may be remedied as the nation's healthcare system implements electronic charting systems.

Not all procedures took longer for patients admitted on the weekend. The report found that weekend-admitted patients requiring appendectomies, treatment for artificial ruptures during labor delivery, care of fractures or dislocated hips and femurs, and patients requiring debridement for wounds or burns were able to undergo their procedures with the same or a shorter time as those admitted during weekdays.

For other procedures, patients admitted on the weekend had to wait until a day after admission. For example, for removal of a clot in a leg artery, 57% of weekend admissions and 65% of weekday admissions received day-of-admission treatment. Exploratory abdominal surgery was performed on the day of admission for 54% of weekend admissions, compared with 60% of weekday admissions.

But the big differences were for patients requiring care of heart disease, non-hip fractures, angina, gall bladder removal, and hernia repair.

For example, patients with heart attacks requiring coronary artery bypass grafts or percutaneous coronary interventions, "a lower share of procedures was performed by the first day after a weekend admission, 64%, than the first day after a weekday admission, 76%.

And 76% of patients admitted for non-hip fractures received treatment compared with 80% of weekday admissions. "The treatment gap did not disappear until day two after admission for both of these conditions."

Asked to comment on the report, members of the American College of Emergency Physicians said it was no surprise.

Richard O'Brien, MD, an emergency physician in Scranton, PA, says the federal report compares "Apples to Volkswagens. You can't compare 'planned admissions' to emergency admits, period. In my shop, most planned admissions are for surgery—obviously planned and therefore multiple disciplines scheduled accordingly.

"Moreover, virtually all admits on weekends are unexpected if not down-right emergencies at least in the patient's eyes. In a world of limited resources, you simply can't measure quality—especially preparedness—between scheduled and episodic events," says O'Brien.

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