Why business hours are bad for hospitals

Updated: Jul 29, 2020

Original author: Vanda McNiven, Ngozi Iroanyah & Zeeshan Ansari

Published: March 23, 2020

Source: Healthydebate.ca



Sickness and accidents can strike at any time of the day or night. We are as likely to fall ill on a Saturday or Sunday as we are on a Monday or Thursday. So why do hospitals have fewer services available after regular business hours?

Only a skeleton crew is typically on duty in hospitals on evenings and weekends. Not only are fewer doctors physically present, but it can be hard to find a social worker, home care worker, imaging technician, physiotherapist, or even a spiritual counsellor.

“It really doesn’t make a lot of sense in this day and age, when everything else in the world is available seven days a week, that we cling to this old five-day model of care,” says Lauren Lapointe-Shaw, an internal medicine physician at the University Health Network in Toronto. This five-day “business hours” model means that patients are often kept in hospital over the weekend because they can’t be safely discharged due to lack of staff, inability to transfer patients to other facilities, or reduced diagnostic testing availability, notes Carl van Walraven, an internal medicine physician at The Ottawa Hospital. THE WEEKEND EFFECT

Several academic studies have confirmed a “weekend effect” on patient care – the observation of a significant increase in mortality when a patient is admitted to hospital on a weekend versus a weekday. These studies suggest that maintaining a more consistent level of service could be economical, even if staff members are paid higher wages on the weekend.

A 2019 review that analyzed 68 studies from around the world found that weekend admission was associated with a 16 per cent increase in the risk of death.

And a 2018 study of Ontario hospitals led by Lapointe-Shaw explored the similarly themed “holiday effect,” or “Christmas effect,” where staffing is decreased on holidays, much like on a weekend. The study found that patients discharged during the two-week December holiday period had a higher risk of dying within the next 30 days than those discharged in late November and January.

Fahad Razak, an internal medicine physician at St. Michael’s Hospital, says that data collected from seven Ontario hospitals through a research network called GEMINI suggests that there is a nearly 50 per cent drop in hospital discharges on weekends.

Discharges home can be delayed because tests like echocardiograms, endoscopies, and MRIs are more easily obtained on a weekday.

Beyond access to diagnostic tests, patients have limited access to physiotherapists and occupational therapists as well. These professionals, among other things, help ensure that a patient’s progress is not set back by a lack of exercise and movement. Elderly patients and those with restricted mobility can deteriorate over the weekend when they remain immobile in bed.

“We have a lot of patients who are at risk to deteriorate if they’re not getting up regularly,” says Andrea Gittens, a transitional care coordinator at the University Health Network. Any progress made during the week can be lost without access to an allied health professional (like a physiotherapist, occupational therapist, social worker, or speech-language pathologist), prolonging their stay.

And with each additional day that a patient spends in hospital, the costs can mount. The average cost of a standard hospital stay in Canada (7 days) was $6,137 in 2017-2018, excluding physician fees.