12-28-2010, 11:35 AM
There's No Good Day to be Sick, But Some are Better than Others
With large institutions such as those that provide police, fire and medical services, we typically perceive these organizations as stable and reliable in their ability to look after our needs when we call upon them. Though some cynics and sceptics might choose to cast doubt on such institutions, these public-facing service providers do, for the most part, protect our safety and well being. However, these institutions are staffed and managed by people and as a consequence, their ability to serve us can sometimes suffer as a result of human factors.
In the delivery of health services, hospitals represent the pillar of accessible public service. When our doctorâ€™s offices are closed and the employees of the after-hours clinics have called it a day, the emergency rooms are always ready to offer health services when we most need them. Outside the emergency rooms, the life-sustaining care in the intensive care unit (ICU) never stops. Nor does the monitoring and care of patients in the various areas of a typical hospital. The core services of the hospital are ever present.
Unfortunately, while access to care may be available, its quality can vary significantly for a number of reasons. However, two important factors that are continually demonstrating an effect on the quality of health care services are the time of day and type of day when we receive treatment. Both of these factors have a human element to them.
One of the forms of treatment that seems to be negatively effected by time and type of day is treatment for stroke. In research from Michigan State University, researchers found that the risk of dying from one type of stroke increased by roughly 13% when patients were admitted to the hospital during evening shifts or on weekends. The particular type of stroke causing this risk increase involved internal bleeding or a hemorrhage. The same research found that the risk of dying from a stroke involving blocked blood flow was roughly 11% higher.
These findings are not an exception either as researchers at other universities have seen similar or even more stark results. Research from the University of California found that for more than 2.4 million hospital admissions involving stroke, that there was a 28% higher chance of dying if hospital admission occurred on the weekend or during evening hours. Again these statistics were for strokes involving a brain hemorrhage. The same study found that the rate of death for strokes involving blockages was about the same, at 12%, as seen by Michigan State University researchers. Research from the University of Virginia also came to the same conclusion.
For those who might attribute these results to US-style for-profit health care, research in Canada by the Institute for Clinical Evaluative Sciences found similar results. Their research found a 15% higher risk of dying from stroke when patients were admitted on weekends or in the evening.
While differences in stroke treatment based on day and time are concerning because of the sheer number of people affected, differences in treatment for other conditions exist as well. In particular, research from the Medical College of Wisconsin found a 22% higher risk of death among patients suffering from stomach and upper intestinal bleeding who were admitted on weekends.
A related study from the University of Calgary found a 10% higher risk of death amongst patients admitted on weekends for bleeding ulcers. As well, the same study also found that weekend admissions increased the length of hospital stays and the cost of the overall treatment.
Though these numbers are significant, they pale in comparison to the results seen for holiday hospital admissions due to bleeding in the stomach and intestines. In a study from the University of Oxford, researchers found a 41% higher chance of dying amongst such patients.
Unfortunately, these holiday-related findings are not isolated to one type of patient health problem. Hip fractures also have a higher risk to those patients admitted on holidays. Research from Hvidovre University Hospital highlighted that the risk of dying within 5 days as a result of hip fracture was 4.4 times higher for holiday admissions compared to weekday admissions. The risk of dying within 30 days was 74% higher for these patients admitted on holidays.
While all these studies were clear in indicating an increased risk of death amongst patients admitted on weekends and holidays, the reasons for these increased risks were less clear. Some of the theories offered include less experienced staff and fewer staff in the hospital caring for patients. The idea is that this can lead to delays in assessment or less thorough assessment of patient health. Other theories suggest that communication and team oriented care may be reduced on weekends.
Regardless of the theories offered, these results suggest an area in which health care services must improve dramatically. While doctors and nurses do need to be able to enjoy their time off, patient health must not suffer. Hospital administrators need to provide the right incentives to staff to ensure a consistent set of skills amongst health care providers within the hospital at any given time of day on any given day. Since patients do not have the option of falling ill on a day of their choosing, consistency of health services at all times is the only option.