Memo to Patients: Don't Get Admitted to The Hospital on a Weekend

(MoneyWatch)  Patients admitted to the hospital on weekends are 30 percent more likely to die there than those who arrive on weekdays. And guess why? It turns out that most doctors are reluctant to work irregular hours, which in turn delays care for weekend patients.

According to a new study from the Agency for Healthcare Research and Quality (AHRQ), delays in treating conditions such as heart attacks, angina, gall bladder problems and complicated hernias were much more common for patients admitted on weekends than for those hospitalized during the week. Just 36 percent of weekend-admitted patients received major procedures on the day of admission, versus 65 percent of those admitted on weekdays.

Of the 19 percent of all hospitalized patients who were admitted on the weekend, 2.4 percent died during their stay. In contrast, only 1.8 percent of patients admitted on weekdays died in the hospital. To some extent, this reflects the fact that far more patients admitted on weekends (65 percent) than on weekdays (44 percent) came in as emergency cases, rather than scheduled admissions.

But both sets of patients had similar characteristics, and their average lengths of stay and costs per admission were close. So the higher number of emergency cases on weekends does not fully explain the higher mortality rate among those patients. Moreover, emergency cases usually require more prompt attention than patients who come in for elective procedures. Delays in providing treatment may "be an indicator of [low] quality of care," the researchers said.

In an organized system of care, an adequate supply of physicians would be available to care for acutely ill patients every day of the week. But in the U.S., specialists and surgeons routinely refuse to be on call at the hospital unless they're paid extra. If they don't have an inpatient procedure scheduled, they'd rather be seeing patients at the office or operating on them in ambulatory surgery centers. And on weekends, they'd rather be home. So the hospitals pay them to come in.

Sixty-two percent of physicians in group practices receive on-call compensation, according to a survey by the Medical Group Management Association. Among those most likely to get paid extra are general surgeons, neurosurgeons, orthopedic surgeons, and ob/gyns. And it's a good bet that they get paid more to attend patients on weekends than their average rate, which ranges up to $2,000 a day for neurosurgeons.

Making matters worse, many patients are only in the ER in the first place because they have no access to their regular physicians. In the U.S. and Canada, three of five doctors have no after-hours arrangements, according to an international study by the Commonwealth Fund. Not surprisingly, U.S. and Canadian patients also have the highest use of the ER for care that could have been provided by their regular doctor.

What this all underlines is the pressing need to create more organized systems of care that put the patient first and ensure that physicians take their turns in providing inpatient care, both during and outside of office hours.

Image supplied courtesy of Science Progress