Improving Weekend Surgical Outcomes

Unless it’s an emergency, having surgery on a weekend is not common, and it’s usually not a good idea. Patients who go under the knife over the weekend generally stay longer in the hospital, are more likely to be readmitted within 30 days and have higher mortality rates, according to the American Association for the Advancement of Science (AAAS).

A paper presented last month at the American Surgical Association meeting spelled out five ways a hospital can help overcome what’s known as the “weekend effect.” They are:

  • increased nurse-to-bed ratio;
  • full adoption of electronic medical records;
  • inpatient physical rehabilitation;
  • a home-health program; and
  • a pain management program.

None of those practices is exactly new or surprising, although rehab as an inpatient might be less common than sometimes it should be. The study seems basically to conclude that weekend patients should be treated no differently from weekday patients, and, really, how groundbreaking is that?

Even though hospitals generally reduce staffing and limit resources on weekends, accidents and illness don’t watch the calendar. If you can buy a quart of milk at 2 a.m. without worrying about the safe and efficient delivery of that service, why can’t you have the same assurance in the middle of Saturday night in the OR?

The paper’s researchers analyzed 126,666 patients at 117 Florida hospitals participating in a database program sponsored by the U.S. Agency for Healthcare Research and Quality. They underwent three types of urgent surgeries that could not be delayed until weekdays: appendectomies, hernia repairs and gall bladder removals.

Researchers analyzed 21 hospital resources, and after controlling for patient characteristics, the five enumerated above were key in helping to help overcome the weekend effect.

  • Hospitals with increased nurse-to-bed ratios were 1.44 times likelier to overcome the weekend effect. Seventeen hospitals that showed such improvement had a median nurse-to-bed ratio of 1.3, compared with a nurse-to-bed ratio of 1.1 among 41 hospitals with a persistent weekend effect.
  • Hospitals with home health programs were 2.37 times likelier to overcome the weekend effect. Their skilled caregivers checked on patients after they were discharged, provided wound care, administered medications, etc.
  • Hospitals that fully adopted electronic medical records were almost five times likelier to overcome the weekend effect.
  • Hospitals with inpatient physical rehabilitation programs were 1.03 times likelier to overcome the weekend effect. These programs identified patients who required additional physical conditioning before they were discharged, or needed extra resources at home.

Of course, if you or a loved one must have emergency surgery, you probably won’t have time to find out if your hospital follows these practices, but if you do have time to make a choice between facilities, these factors should help you decide where to go.

See our backgrounder on surgical errors; if you do have a poor outcome after weekend surgery, it might help you determine if it’s time to see a lawyer.

And see Patrick’s newsletters about how to make a smooth and successful transition from hospital to home, and pain management programs.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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