Update: I’ve changed the headline, because people kept answering the wrong question.:-) The right question is here:
Attention patient voices around the world: what questions should researchers look at to see if there is a difference between weekend and weekday services in hospitals?
In the UK a major debate is underway about the weekend effect in hospital services: are they less safe, how are they different, etc? The image at right, from Wikipedia, is one example: the red line shows that death rate for stroke patients improves dramatically when nurse coverage is not close to zero.
I’m on the BMJ editors’ patient panel, and Rosamund Snow, the BMJ’s patient editor, points out that from the patient’s perspective there’s a lot more to look at than death rate.
That’s a pretty crude measure of whether a hospital’s performance is affected, eh? “What are you complaining about? She didn’t die, did she?” What about things like falls, medication errors, access to needed surgery, and on and on and on.
So Rosamund has decided to seek patient thoughts on the subject, hallelujah.
Of course UK experience is important but what are your experiences in any country? Mostly we’re seeking patient experience, but physician experience in other countries could be useful, especially if a system made a change that created a clear difference, better or worse. Both data and anecdotes are welcome.
Most important, though: What questions should researchers look at to see if there is a difference between weekend and weekday services?
Not being able to get services on the weekend. That’s happened before. Or they are so backed up from the weekend getting everyone done, it takes TWO DAYS for services to happen.
I always try and leave hospital by a Friday – if I’ve been admitted. I’ve avoided going to emergency on a weekend – I will wait till Monday – even through extreme pain. I avoid being in the hospital over the weekend at (almost) all costs. I’ve even considered checking myself out of hospital on a weekend – even with IVs and concerns. My experience has been that nothing constructive happens on the weekends. I’ve been in hospital many times in my lifetime and my experience has been consistent.
What questions do you think researchers should look at, to understand the situation? Are you saying they should examine whether anything useful ever happens on the weekend? (Fascinating thought…)
Nothing constructive happens, limited feeling of safety when admitted with emergency issues.
From Facebook:
Peter Elias MD, primary care physician (recently retired) in Maine:
I would look at weekend discharges as a high-risk and high-impact issue. Are transition services and support available or does the patient go home Saturday and then on Monday the process of putting support in place begins? Does the patient go home in time to get to the pharmacy? If the patient goes home on a weekend and has questions or problems, who does she call?
Also from Dr Elias on Facebook:
Another area for questions related to weekends: weekends may be a time when more of the support team is able to visit and work with the patient and care team. Family working with PT/OT, for example. Or team meetings about discharge planning, long term issues. Does this happen, or is the support team forced to adapt to the M-F 8-5 institutional mentality? Same question about clinicians: are the folks rounding on weekends (hospitalists and consultants) the ‘real’ team or just filling in and therefore not up to speed?
They need to ask whether or not support services are available. I had a PICC line that waited 2 extra days because they were so backed up. They didn’t have them available on the weekend. The nursing staff was where you could call for 1/2 hour and not get anything. They had given them an extra hall with 5 more patient rooms. I couldn’t be released on the weekend because there was no one to release me. Its a hospital and you can’t find a doc to release someone?
I’d say not just nursing staff but MD’s. Do they have them available on weekends, and are they familiar with the case or not.
I’m in the US and my experience has been that if you aren’t released by Friday, you will be in the whole weekend. The weekend staff is not the regular staff, and they are not likely to make decisions about releasing the patient – would rather leave that for the primary doctor. As a patient, you do notice a drop in staff, and you are dealing with staff that are not as up-to-date with your situation. I do realize that the regular staff does need to have their time off, but that has been my experience.
But what questions should researchers be looking at?
How often did you see your nurse, hospitalist, and other care team members on the weekend? Was there a flurry of activity at the beginning of their [12-hour] shift, and then no one around? How does this compare with the activity and medical staff visits M-F?
Did you call for help using your call button on the weekend? What was the nature of your need(s)? How long did it take for someone to respond?
Did you have a family member or friend staying with you on the weekend? Did they need to advocate for you or get help on your behalf? What was this experience like? Did your family member or friend comment on the weekend care; if so, please explain.
Did you feel safe in your hospital on the weekend compared to M-F? Please describe.
In what ways would you suggest the hospital could change or improve weekend care?
Do you have an additional feedback on weekend care in the hospital?