Toronto In-Home Care Blog

The Weekend Effect: Getting Better Care in the Hospital

Posted by Steve Jones

Sat, Oct 4, 2014

hospital_in_bedPeople get sick 24 hours a day – in the middle of the night, on weekends, and (gasp) even on holidays. Hospitals are open 24/7/365, but are typically staffed with perhaps only a third as many doctors on weekends as they would have on any weekday. Doctors may be “on-call,” supposedly waiting at home with phone in hand, but it can still take 30 minutes or more for a specialist to get to the hospital and be ready to see a critically ill or injured patient.

Nurses are usually staffed at close to weekday levels, but physiotherapists, dieticians and other health professionals who aren’t MDs, but are just as critical to the health, comfort, and sometimes even the survival of patients get weekends and nights off. It’s commonly cited as a trade-off for the fact they don’t make as much as doctors.

Go into any hospital at 2:00 a.m. and it will seem absolutely deserted. It’s true that most patients already in the hospital will be sleeping, requiring, for the most part, less intensive care; but what happens to the patient who arrives at 1:00 a.m. after a heart attack, and seems to be stabilized, so the doctor goes home, deciding not to perform angioplasty in the middle of the night, even though it’s critical to open clogged arteries within 90 minutes of a heart attack. If the patient suffers another attack an hour later, death is much more likely than if they had received angioplasty.

The Weekend Effect

Since 2001, when a study was published in the New England Journal of Medicine, the increased risk of death on nights and weekends has become known as the “weekend effect.” For most health conditions, the relative increase in deaths is small but statistically meaningful. If it’s your loved one in the hospital who is at increased risk, that statistically small number is even more meaningful.

Another effect is medication errors. For patients whose health situation is complex, the lack of doctor availability on weekends could mean that adding another medication causes unforeseen, sometimes dangerous, side effects, because the pharmacist can’t reach the doctor to consult on a better solution.

So what can you do?

You can’t control when and how you get sick enough to enter the hospital. You can’t control getting shoved on the street to fall and break a hip. In an emergency, you may not even be able to control which hospital you end up in – EMTs will take you to the nearest one. When you’re in pain, you may not even be able to think straight enough to understand what the doctor is telling you, to make an informed decision. So how can you get better care in the hospital on weekends and at night?

Until the system changes, as it could and will with enough community pressure, you have to work within the system. It is safest to have an advocate who is well trained in handling the kind of situations you might encounter in the hospital. An advocate should be able to handle post-operative care, rehabilitation, navigating the health care system, and advocating for your needs with nurses, doctors and other medical professionals. They can also help with personal care and toileting, walking and meal assistance, even simple companionship. Having that extra support ensures comfort and safety and may prevent  complications and reduce the length of the hospital stay. It could even save your life.

If your family doesn't have the availability or training to send a family member as an advocate for long periods of time, Qualicare Toronto offers personal hospital support get better hospital care: timely care of the highest quality. Our experienced caregivers will make sure you receive the best care possible.

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Topics: Family caregivers, Healthcare system