Hospital Care: Worse on Weekends? | Newsweek Fact or Fiction

A new study finds that when you're treated can make a difference.

By Katie Paul | Newsweek Web Exclusive

Feb 19, 2008 | Updated: 4:14 p.m. ET Feb 19, 2008

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If you could control when you got sick enough to need hospital care, it might be worth doing. According to a new study coming out in the Feb. 20 issue of the Journal of the American Medical Association, hospital care may be significantly worse on the weekends and at night than on weekdays. After reviewing the survival rates among patients across the country who experienced cardiac arrest during their hospital stays, researchers at Virginia Commonwealth University found that patient mortality rates were higher at certain times of day and on weekends, even when they factored in clinical variables like the patient's condition and what the different heart rhythms were.

"We looked at a tremendous number of patients at a comprehensive cross-section of hospitals around the country and found that survival was substantially lower at night, compared to day and evening, and on weekends regardless of what time of day it was," says Dr. Mary Ann Peberdy, who directed the study.

Peberdy and her colleagues looked at data on 86,748 adult in-hospital cardiac arrests occurring at 507 hospitals between 2000 and 2007, and found that the survival rate during weekdays and weekday evenings was 20.6 percent, while the survival rate on the weekend was only 17.4 percent and an even more disturbing 14.7 percent at night. That means patients were about 41 percent more likely to survive if they were treated during the day from Monday to Friday.

This isn't the first study to find a marked difference in hospital patients' outcomes depending on when they are treated. A smaller report on heart attack survival rates at New Jersey hospitals came out last March in the New England Journal of Medicine that indicated similar trends involving weekend care and survival rates.

Although the conclusions focused on proving correlation rather than causation, Peberdy cites short-staffing issues as a likely culprit in the lower survival rates at certain times during the week. Fewer staff members could lead to less frequent monitoring of patients and a significantly slower response time in identifying and treating a patient in distress, she says.

"When someone has a cardiac arrest, they typically begin with a rhythm you can treat with a shock. Then, if it goes unrecognized, it degenerates into rhythms that have poorer survival rates," says Peberdy. "In our study, we found that the percentage of shockable rhythms got lower at night, while the other types got higher. The fact that these rhythms switch at night and on weekends suggests that [cardiac arrests] are being found a little bit later. Surveillance decreases at night, because the staff just isn't there. And not every patient is on a monitor, so you rely on staff walking in and out of the room to find them when they've had a cardiac arrest."

It is amazing to me that people outside of hospitals are just now figuring this out - nurses who work in hospitals have known this for years.

Weekends and evening/night shifts are always less staffed; there are more patient falls, more medication errors, more complications, more adverse incidents of every kind, because there are less nurses. Ironically, the only type of hospital admissions that occur on weekends and evening/night shifts are emergency admissions - planned admissions only occur during the day, when there is enough staff. (Translation: enough surgeons scheduling surgery).

As already stated by another RN in this post, I have stayed overnight with both of my parents when they had major surgery, and the nursing staff of those units were grateful to have me there - one less patient they had to focus on.

The night my father had his surgery, there were 2 nurses on duty for 30 patients, and there were 6 emergency surgical admissions, in addition to the regularly scheduled surgical patients from that day. This was a small, private for-profit hospital in NY in an affluent area, 20 miles from Manhattan. That hospital had jobs posted for night shift charge nurses, starting pay $70,000/year, in 2001, and they still couldn't hire enough night shift nurses. You can only imagine how bad the staffing is in rural, inner-city and municpal-run not-for-profit hospitals.

The article mentions interns working long hours, not enough attending physicians available weekends and evening/night shifts, but it is the poor nurse-to-patient ration that is the problem, not the availability (or lack of availability) of interns and residents.

The American Nurses Association, as well as dozens of nursing schools, have done study after study that show improved patient outcomes are directly related to the the number of registered nurses available. Length of stay, the number of hospital acquired infections, surgical complications, patient falls, and amazingly, nursing staff turnover all decrease when there are enough nurses at the bedside.

Hospitals are set up for the care and comfort of physicians, specifically, surgeons. What may be best for the nurse, and certainly, what is best for the patient, is always secondary.

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Posted By: C. MacLean @ 03/01/2008 8:16:30 PM

It is amazing to me that people outside of hospitals are just now figuring this out - nurses who work in hospitals have known this for years.

Weekends and evening/night shifts are always less staffed; there are more patient falls, more medication errors, more complications, more adverse incidents of every kind, because there are less nurses. Ironically, the only type of hospital admissions that occur on weekends and evening/night shifts are emergency admissions - planned admissions only occur during the day, when there is enough staff. (Translation: enough surgeons scheduling surgery).

As already stated by another RN in this post, I have stayed overnight with both of my parents when they had major surgery, and the nursing staff of those units were grateful to have me there - one less patient they had to focus on.

The night my father had his surgery, there were 2 nurses on duty for 30 patients, and there were 6 emergency surgical admissions, in addition to the regularly scheduled surgical patients from that day. This was a small, private for-profit hospital in NY in an affluent area, 20 miles from Manhattan. That hospital had jobs posted for night shift charge nurses, starting pay $70,000/year, in 2001, and they still couldn't hire enough night shift nurses. You can only imagine how bad the staffing is in rural, inner-city and municpal-run not-for-profit hospitals.

The article mentions interns working long hours, not enough attending physicians available weekends and evening/night shifts, but it is the poor nurse-to-patient ration that is the problem, not the availability (or lack of availability) of interns and residents.

The American Nurses Association, as well as dozens of nursing schools, have done study after study that show improved patient outcomes are directly related to the the number of registered nurses available. Length of stay, the number of hospital acquired infections, surgical complications, patient falls, and amazingly, nursing staff turnover all decrease when there are enough nurses at the bedside.

Hospitals are set up for the care and comfort of physicians, specifically, surgeons. What may be best for the nurse, and certainly, what is best for the patient, is always secondary.
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Posted By: TXRNMSN @ 02/22/2008 8:39:02 PM

I am also an RN. I second your statements.

The staffing and patient safety issues need to fall squarely on the shoulders of the administration. Until hospital administrators and the corporate board of directors are held accountable or are in danger of prison sentences, this unsafe atmosphere will continue. They ultimately decide the staffing ratios that exist.

I personally sit at the bedside of family or friends when they are hospitalized because of this staffing nightmare.