Journal of General Internal Medicine

, Volume 26, Issue 9, pp 1050–1052 | Cite as

Excellent Hospital Care for All: Open and Operating 24/7

Perspectives

ABSTRACT

Nights and weekends are the times when most people are admitted to the hospital. They are also synonymous with reduced staffing levels and fewer specialized diagnostic, procedural, and treatment options. Indeed, there is increasing evidence suggesting that patient care is compromised during these times. Equally important is the inefficient use of capital investments during nights and weekends, and inappropriate utilization of hospital beds caused by poor weekend discharge flexibility. We believe that these findings should be of concern not just to hospital care providers, but across care settings and to the general public. In this perspective article, we highlight how our current office-hours system of running hospitals threatens the lives of our sickest, most vulnerable patients, describe solutions currently implemented in hospitals that may alleviate this disparity, and discuss challenges to wider scale implementation.

KEY WORDS

nights and weekend hospital care quality and safety efficiency 

Notes

Contributors

None

Funders

None

Prior Presentations

None

Conflict of interest

None disclosed.

REFERENCES

  1. 1.
    Aujesky D, Jimenez D, Mor MK, Geng M, Fine MJ, Ibrahim SA. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation. 2009;119(7):962–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Kostis WJ, Demissie K, Marcella SW, Shao YH, Wilson AC, Moreyra AE. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med. 2007;356(11):1099–109.PubMedCrossRefGoogle Scholar
  3. 3.
    Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001;345(9):663–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Kazley AS, Hillman DG, Johnston KC, Simpson KN. Hospital care for patients experiencing weekend vs weekday stroke: a comparison of quality and aggressiveness of care. Arch Neurol. 2010;67(1):39–44.PubMedCrossRefGoogle Scholar
  5. 5.
    Bendavid E, Kaganova Y, Needleman J, Gruenberg L, Weissman JS. Complication rates on weekends and weekdays in US hospitals. Am J Med. 2007;120(5):422–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Miller AD, Piro CC, Rudisill CN, Bookstaver PB, Bair JD, Bennett CL. Nighttime and weekend medication error rates in an inpatient pediatric population. Ann Pharmacother. 2010;44(11):1739–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Peberdy MA, Ornato JP, Larkin GL, et al. Survival from in-hospital cardiac arrest during nights and weekends. Jama. 2008;299(7):785–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Cram P, Hillis SL, Barnett M, Rosenthal GE. Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med. 2004;117(3):151–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Shojania KG, Fletcher KE, Saint S. Graduate medical education and patient safety: a busy–and occasionally hazardous–intersection. Ann Intern Med. 2006;145(8):592–8.PubMedGoogle Scholar
  10. 10.
    Shulkin DJ. Assessing hospital safety on nights and weekends: the SWAN tool. J Patient Saf. 2009;5(2):75–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Arabi Y, Alshimemeri A, Taher S. Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage. Crit Care Med. 2006;34(3):605–11.PubMedGoogle Scholar
  12. 12.
    Carr BG, Jenkins P, Branas C, et al. Does the trauma system protect against the weekend effect? In: Eastern Association for the Surgery of Trauma 23rd Annual Scientific Assembly. Phoenix, AZ: 2010.Google Scholar
  13. 13.
    Khanna R, Wachsberg K, Marouni A, Feinglass J, Williams MV, Wayne DB. The association between night or weekend admission and hospitalization-relevant patient outcomes. J Hosp Med. 2011;6(1):10–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Arriaga AF, Elbardissi AW, Regenbogen SE, et al. A policy-based intervention for the reduction of communication breakdowns in inpatient surgical care: results from a harvard surgical safety collaborative. Ann Surg. 2011.Google Scholar
  15. 15.
    Qureshi SA, Ahern T, O'Shea R, Hatch L, Henderson SO. A standardized code blue team eliminates variable survival from in-hospital cardiac arrest. J Emerg Med. 2011.Google Scholar
  16. 16.
    Carr BG, Nance ML. Access to pediatric trauma care: alignment of providers and health systems. Curr Opin Pediatr. 2010;22(3):326–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee LH, Swensen SJ, Gorman CA, Moore RR, Wood DL. Optimizing weekend availability for sophisticated tests and procedures in a large hospital. Am J Manag Care. 2005;11(9):553–8.PubMedGoogle Scholar
  18. 18.
    Wong H, Wu RC, Tomlinson G, et al. How much do operational processes affect hospital inpatient discharge rates? J Public Health (Oxf). 2009;31(4):546–53.CrossRefGoogle Scholar
  19. 19.
    Wong HJ, Wu RC, Caesar M, Abrams H, Morra D. Smoothing inpatient discharges decreases emergency department congestion: a system dynamics simulation model. Emerg Med J. 2010;27(8):593–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Sovie MD, Jawad AF. Hospital restructuring and its impact on outcomes: nursing staff regulations are premature. J Nurs Adm. 2001;31(12):588–600.PubMedCrossRefGoogle Scholar
  21. 21.
    Rothschild JM, Bates DW, Franz C, Soukup JR, Kaushal R. The costs and savings associated with prevention of adverse events by critical care nurses. J Crit Care. 2009;24(3):471. e1-7.PubMedGoogle Scholar
  22. 22.
    Gajic O, Afessa B, Hanson AC, et al. Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital. Crit Care Med. 2008;36(1):36–44.PubMedCrossRefGoogle Scholar
  23. 23.
    Iglehart JK. Grassroots activism and the pursuit of an expanded physician supply. N Engl J Med. 2008;358(16):1741–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Moseley A, Jeffers L, Paterson J. The retention of the older nursing workforce: a literature review exploring factors which influence the retention and turnover of older nurses. Contemp Nurse. 2008;30(1):46–56.PubMedCrossRefGoogle Scholar
  25. 25.
    Utriainen K, Kyngas H. Hospital nurses' job satisfaction: a literature review. J Nurs Manag. 2009;17(8):1002–10.PubMedCrossRefGoogle Scholar
  26. 26.
    Hamilton P, Eschiti VS, Hernandez K, Neill D. Differences between weekend and weekday nurse work environments and patient outcomes: a focus group approach to model testing. J Perinat Neonatal Nurs. 2007;21(4):331–41.PubMedGoogle Scholar
  27. 27.
    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.PubMedCrossRefGoogle Scholar
  28. 28.
    Greenwald JL, Denham CR, Jack BW. The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf. 2007;3(2):97–106.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  1. 1.Institute for Technology Assessment and Department of ImagingMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Centre for Innovation in Complex CareUniversity Health NetworkTorontoCanada
  3. 3.Division of General Internal Medicine, Department of MedicineUniversity Health Network, University of TorontoTorontoCanada
  4. 4.Toronto General HospitalTorontoCanada

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