On weekends, it’s better to be shot than have a heart attack

During the week I pass my time either performing the functions of an internal medicine residency program director or seeing patients at a clinic for underserved populations.  One weekend per month, however, I shift gears and cover the hospitalist service at a local hospital.  I like the atmosphere of the hospital on a weekend:  it’s much less busy and in general more relaxed.

The downside of this pleasant environment is what’s known as the “weekend effect”, a proven phenomenon wherein patients admitted to the hospital with time-sensitive conditions on a Saturday, Sunday, or after hours do more poorly than those admitted during regular business hours.  It’s attributed in part to the fact that most hospitals are functioning with minimal staff on weekends, making it more difficult to rally providers when needed.

A new pilot study, however, demonstrates that people who suffer traumatic injuries during those times are spared from this effect.

People who are in car crashes or suffer serious falls, gunshot or knife wounds and other injuries at nights or on weekends do not appear to be affected by the same medical care disparities as patients who suffer heart attacks, strokes, cardiac arrests and other time-sensitive illnesses during those “off hours,” according to new research from the University of Pennsylvania School of Medicine. In contrast to previous, multi-hospital studies showing that patients treated for cardiac or neurological emergencies overnight and on weekends are more likely to experience complications and even die than those who come to the hospital on weekdays, the new pilot findings suggest that trauma patients are insulated from this so-called “weekend effect” tied to the time of day in which they’re brought to the hospital.

via Penn Medicine News: Trauma Patients Safe from Mortality Risks, Complications Associated With So-Called “Weekend Effect”.

The authors reason that the more rigid staffing requirements of trauma centers are responsible for this finding.  I should clarify that not all hospitals are trauma centers.  In order to gain the distinction of a trauma center, a hospital must meet additional requirements, including having a trauma surgeon immediately available 24/7.

This being a pilot study, more studies will be needed to verify these results.  But if validated, this study raises what is perhaps an obvious question:  if we know that people do more poorly on weekends, and we have evidence that better staffing=better outcomes, how do we justify keeping our hospitals minimally staffed on weekends?

I’m not sure we can.  And although I’ll miss the laid-back weekend hospital atmosphere, it’ll be worth it if it helps patients.