What Is the “Weekend Effect”-and Why Does It Matter?

Do patients who are hospitalized on the weekend have worse outcomes?

Theoretically at least, every day in any hospital should be the same. That means that every patient should be treated with the same quality and safety standards whether it be Sunday or Wednesday. In reality, however, the evidence suggests that there is a “weekend effect,” which translates into worse outcomes for patients admitted to the hospital on weekends for serious illnesses.¹

It has been suspected that reduced access to intensive treatment and a concurrent decrease in staffing may render weekend care of lesser quality than weekday care.¹ Recently, 2 studies compared weekend and weekday care for patients with upper GI bleeding from a variety of sources.^2,3

ADMISSIONS FOR UPPER GI BLEEDING: WEEKEND VS WEEKDAY CARE

Before these studies, the proposed weekend effect had not been evaluated in regard to GI bleeding, at least not in significant detail. The first study found a 22% increase in the risk of death for patients who were admitted on weekends with upper GI bleeding from a nonvariceal source, compared with those who were admitted on a weekday. In addition, these weekend patients were 64% less likely to undergo endoscopy to define the source of bleeding on the first day of hospitalization. Among patients with variceal hemorrhage, the weekend effect translated into a 65% lower likelihood of “early” endoscopy, but there was no increase in mortality.²

The second paper addressed the weekend effect on peptic ulcer–related upper GI bleeding. Again, weekend admission was associated with an increase in mortality (specifically, an odds ratio of 1.08 compared with weekday admission), which stood the test of a multivariate analysis. The delay to endoscopy averaged 2.21 days for weekend admissions. Complications included an increased rate of surgery to control the bleeding source, apparently as a result of the delay in undergoing endoscopy. These findings came from a total of 237,412 admissions to 3166 hospitals, all for peptic ulcer–related upper GI bleeding.³

THE COST OF THE WEEKEND EFFECT

The results of these 2 studies show that weekend admissions for acute upper GI bleeding are associated with longer hospital stays, increased complications, and a potential increase in the need for surgery, compared with weekday admissions. All of these add up to a rise in costs.

From a safety perspective, the decrement in quality related solely to the day of the week is troubling. The data were publicized by Reuters and other news agencies,⁴ so patients and their families will be aware of the discrepancies. We have to be prepared for their questions and concerns.

A STEP IN THE RIGHT DIRECTION

The last decade has seen an increase in hospitalists. That change has had a demonstrable benefit for weekend care, presumably because of the immediate availability of in-hospital management every day and night (“nocturnalists”). The next step may be a similar coverage model for subspecialties as well. Remember that these Top Papers are not the first studies to suggest a weekend effect and that our patients, families, friends and, yes, we too can become seriously ill on a weekend.

References:

REFERENCES:

1.

Fiore K. “Weekend effect” noted in patients admitted for GI bleeding.

. Published March 5, 2009. Accessed May 22, 2009.

2.

Ananthakrishnan AN, McGinley EL, Saeian K. Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis.

Clin Gastroenterol Hepatol.

2009;7:296-302e1.

3.

Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease.

Clin Gastroenterol Hepatol.

2009;7:303-310.

4.

Bleeding ulcer outcomes worse on weekends.

http://www.reuters.com/ article/healthNews/idUSTRE5253IZ20090306

. Published March 6, 2009. Accessed May 22, 2009.