Hospital Patients More Likely To Die On Weekends

People admitted to the hospital on the weekend are 10 percent more likely to die than those who checked in during the week, according to a new analysis of nearly 30 million people.

Even if 10 percent doesn't sound like much of a difference, when applied to the entire U.S. population it equals an additional tens of thousands of people each year, study author Dr. Rocco Ricciardi of Tufts University Medical School told Reuters Health.

"In other words, an extra 20 to 25 thousand people die each year in the United States because of admission on a weekend," he said.

This is not the first study to uncover a "weekend effect," in which patients are likely to fare worse during the weekends. Previous research has shown a "weekend effect" for patients admitted to the hospital for heart attack, a blood clot in a lung, a ruptured abdominal artery and strokes of all kinds.

Still, the data are not always consistent: earlier this year, a survey of Pennsylvania hospitals found that people with injuries fare slightly better on weekends.

The current study is based on an analysis of a national sample of close to 30 million people who were admitted to hospitals in 35 states over a 5-year period. All were admitted for "non-elective" reasons, which represents most admissions, Ricciardi noted.

Reporting in the Archives of Surgery, he and his colleagues found that 2.7 percent of the people admitted during the weekend died while in the hospital, which happened to only 2.3 percent of those admitted on a weekday.

It's not entirely clear why people might fare worse when they come in during the weekend, Ricciardi said in an email. Looking specifically at traumas, he and his colleagues found no differences in death rates between weekend and weekday arrivals, which helps eliminate the possibility that people experience more life-threatening accidents on weekends.

But it's possible that care is different on weekends, he said — perhaps there is less nursing, fewer well-trained doctors, or less access to imaging and other necessary tools.

"Either (1) the patients coming to the hospital on weekends are sicker or else (2) the hospital is doing a worse job of treating them," said Dr. Raman Khanna at the University of California at San Francisco, who was not involved in the study.

Since the researchers found no differences in trauma rates, and also took into account whether weekend arrivers had other illnesses that could make them sicker, "the authors can make the case that number 2 is more likely," he told Reuters Health in an email.

Ricciardi and his team also looked at death rates by admission day for different diagnoses, and saw that not all fared worse on the weekends. This is likely because some categories — such as trauma — have specific steps that are followed each time, said Ricciardi. "Thus services are the same whether it is nighttime, daytime, or weekend or weekday."

The categories that did fare worst on weekends included problems with pregnancy and the female reproductive system, blood cell and bone marrow disorders, and circulatory and nervous system problems.

The findings suggest that hospitals should focus their efforts on those specific conditions, Khanna said, "rather than a blanket increase in nursing ratios for everyone at every hospital over the weekend, since a more tailored solution may be just as effective while far less expensive."

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  • by Nurse susieQ Location: PCMH on May 29, 2011 at 05:52 AM
    I have had a meeting called and all but two RN's left on the floor for forty patients and that lasted for an hour and it was at PCMH. It is a dangerous place to work. For those of you who think it doesn't happen your blind or not an RN. Complain to whoever you like they will find something against you to terminate you. I have witnessed it. THIS IS A RIGHT TO WORK STATE.
  • by don Location: enc on May 22, 2011 at 01:11 PM
    no dog in this fight and 50 pts seems unlikely to say the least but for those who mentioned BON I would say contact BON,JCAHO,, and NCLABOR and you will be told there are NO statutes or regs in NC that would prohibit any number of patients assigned to a given nurse. Many other states have such rules but no good ol NC. NC also has no mandatory overtime restrictions and according to the lawyer at nclabor ( nc osha) a nc employer can make a worker work literally 24/7 with no break and either the employee or employer is free at anytime to sever the relationship if they dont like the conditions of employment or the quality of work done
  • by c Location: enc hospital RNC on May 22, 2011 at 08:15 AM
    this is one reason why NC nurses dont have it better than we do. Number 1 we cant collectively bargain due to 1959 law,( at least public sector nurses cannot) and that keeps us way behind nurses from other states in pay and benefits and working conditions. Then when nurse speaks out on a really bed work environment, just because most of us have not been in that particular bad situation ( most commenters seem to be from PCMH, which has been rated among the best to work at nationwide ) people are saying "nurse" is a liar or not even a nurse at all. I have , in 26 years as an RN been in really bad situations where you could try to reach out to OSHA, NCBON etc but more often in NC they would say " this is an at will employment state take it or leave it" and I have had as many as 14 med surg patients ( the doctors at that hospital finally went to administration and fixed that situation for us, demanding more nurses) and as many as 35 Psych ( who do also become ill and need "real " nursing care) so I wouldnt be surprised if a nurse had 20 plus patients, some of you maybe have just had it good where you are and thats great , but we should all belobbying for better conditions for all staff and patients not attacking each other. As for the topic of story I have definitely noticed the " after5 " effect and when I have a friend or relative in hospital I try to make sure they have a private aide at bedside after hours
  • by BCMC-RN on May 22, 2011 at 07:34 AM
    No hospital staff nurse has 50 pts to 1 nurse. Get real people!!
  • by RN Location: PCMH on May 22, 2011 at 03:20 AM
    Are you kidding? 50 patients for 1 nurse? Maybe you are referring to NURSING HOMES rather than HOSPITALS. If you think for ONE MINUTE any person in health care is going to believe 50:1 ratios, you need to have your license revoked because you CANNOT ADD!!! Get real and stop pretending that you are a nurse!!!
  • by gina Location: rex on May 21, 2011 at 06:30 PM
    the BON governs only nurses licenses so you could call them and complain about being assigned 100 patients, or working 100 hours it doesnt matter they ( BON) have no authority over hospitals just nurses
    • reply
      by Another RN on May 22, 2011 at 04:18 AM in reply to gina
      GINA- I didn't say they had any authority- I just said they would know about it. Are you honestly saying they don't care? That they wouldn't support the Nurses? Wow, Who do you think keeps hospital running? I can give you At least 2 examples where PCMH terminated a Nurse, Said Nurse complained to the BON, BON said they were wrongly terminated, PCMH gave them their Jobs back. Of course they didn't have to but they knew better then to go against the BON. Your obviously not a Nurse or you would understand.My point was, if this really did happen somewhere, although I have yet to see the name of the hospital where Nurses have 50 patients, the BON would know about it. Again, I've traveled all over and the Nurse to patio Ratio at PCMH is Below average. They have there problems but This weekend thing isn't one of them nor is the Patient ratio. PCMH is Top Dog on this one.
  • by Carmine Location: Washington on May 21, 2011 at 03:40 PM
    I've been knowing this for years. It's a plain and simple fact!! The "Top Dog" doctors and every other "Top Dog" is off on the weekends. Incoming patients basically get the "lackeys". It's like that in alot of businesses. Also, there's something called the "after five" effect. These same people are off after 5pm, so you get sort of the same thing. I'm not picking on anyone, it's just the way it is. Hospitals should have the "Top Dogs" working on the weekends as well. It's a place where lives are seriously at risk all the time. The weekends should be the same as any other day; because it's a HOSPITAL FOR CRYING OUT LOUD!!
    • reply
      by RN on May 21, 2011 at 05:32 PM in reply to Carmine
      That is absolutely not True, Maybe at some of the smaller hospital but I can tell you for a fact, not at PCMH or Duke or any of the Teaching hospital. Saw a "Top Doc" today and I can guarantee you I will see another 1 or several Tomorrow. Ever heard of a Dr. Chitwood? if not look him up. I'm pretty sure he's cosidered a Top Dog as you put it. Seen him before on weekends, More than once. Your theory may work at some hospitals but NOT ALL, Not here and believe me, I'm the first to criticize PCMH if needed, But not this time. There staffing on weekends are the same as during the week, "Top Dog Doctors" DO WORK WEEKENDS and Nurses DO NOT have 50 patients.
      • reply
        by voter on May 21, 2011 at 08:43 PM in reply to RN
        RN, you are right on the money. The doctors and staff at PCMH are among the finest. "Top Dog" doctors making their rounds well into the night is not uncommon. Another big plus at PCMH is, they don't clean their surgical instruments in used hydraulic fluid. Carmine seems to like better it where he came from.
        • reply
          by Anonymous on May 22, 2011 at 03:35 AM in reply to voter
          Thats a low blow, but every hospital has its dirty secrets.
      • reply
        by BCMC RN on May 22, 2011 at 07:32 AM in reply to RN
        I don't see this happening in your smaller hospitals either. We have some very good hospitals in NC. This study sounds a little weird to me!
  • by Formerly O.L.I. Location: ENC on May 21, 2011 at 02:11 PM
    Isn't family more likely to visit on weekends?
  • by ? Location: been there on May 21, 2011 at 02:09 PM
    "listening out" does not exist. When one RN leaves for lunch, class, meeting etc another nurse is not just listening out. That is your patient while the other person is gone, be it for a 10 minute break or a 2 hour mandatory meeting. I dont know what hospital "Nurse" is referencing, but Cherry hospital in Goldsboro is where the recruiter quit and told newsobserver that she couldnt look herself in mirror anymore for all the lies to get nurses to come there. I was there for a 13 week contract and had 22 patients so it might be possible
    • reply
      by ANother Nurse on May 21, 2011 at 04:49 PM in reply to ?
      To "?"- your actually comparing Cherry Hospital- The Psych hospital- to an actual hospital like PCMH or Duke. REALLY, are you serious. I'm still waiting on that Nurse to tell us what Hospital she worked at that had "50" patients. As far as your comment about listening out, do you document on those patients? Give their scheduled Meds? Do you round with the doctors if they happen to come to the Floor? Those are the things that make them "your" patients. On a general Med/Surge- Tele Floor You would NEVER have more than 10 patients, and even then it would be some type of disaster or numerous call outs and I guarantee the BON would hear about it. Come on, someone please tell me at what hospital a RN has 50 patients. I've worked weekends for the past 6-7 years, most of that as a traveler. Staffing is not the problem, it's the smaller, community hospitals that don't have residents. At PCMH, there is ALWAYS a resident and Attending within shouting distance, or at least can respond to a code in less than a minute.
  • by Anonymous on May 21, 2011 at 10:26 AM
    In my experience it does seem that more things are likely to go wrong on the weekend. My mother was hospitalized for 10 months straight and she'd take three steps forward during the week and two backwards on the weekends. It had nothing to do with patient/nurse ratio. In her case, it was having on call doctors nad interns that knew little about her case caring for her. DOctors can't be on call 24/7 and on call doctors and interns must be utilized. She had fantastic nurses and doctors but with a skeleton crew and people not familiar with her case, it made for some scary weekends and nights.
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