Why Do Hospitals Slow Down on Weekends?

Hospitals start most weeks with a low occupancy but quickly get to gridlock by early to mid-week, driven by elective scheduled admissions. This bunching of scheduled admissions has now been shown to severely affect the ability of nursing and other staff to provide quality care. A recent study showed that patient exposure to understaffed nursing units and increased patient turnover (admission, discharge and transfer) activity each have a statistically significant effect of increased hospital inpatient mortality. Another study established a link between the risk of readmission and a peak in admissions to an ICU.

In addition to increased mortality and readmission risk, mid-week gridlock imposes significant delays for new admissions to the hospital manifested as emergency department (ED) diversion, ED and Post-Anesthesia Care Unit boarding, and placement of patients in inappropriate care locations. To compensate for patient placement issues hospitals resort to specialized care provider teams that are deployed when patients deteriorate because of inadequate care. Medically appropriate transfers from other institutions may also be delayed or rejected.

Patients who are in the hospital over the weekend fare even worse. Patients who are admitted over the weekend have an increased risk of morbidity and mortality because critical diagnostic or therapeutic modalities are not available. Existing inpatients also experience weekend delays at best, and deterioration in clinical condition at worst, for the same reasons. Chemotherapeutic protocols may be interrupted, post-surgical rehabilitation prolonged, and medical diagnosis delayed because key physicians or services are not available.

More from Michael Long and Sandeep Vaswani at Health Affairs Blog.

Comments (5)

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  1. Devon Herrick says:

    Retailers provide access to Parmigiano Reggiano and other specialty goods 24/7 in most major cities across the country. Yet, hospitals have a hard time staffing on weekends. This is a function of the bureaucratic nature of our health care – mostly due to over-reliance on third-party payment.

  2. Greg says:

    They do what they do becase they are inefficient and the market is not competitive enough to make them efficient.

  3. Brian Williams. says:

    At first glance, I’d say this is normal. Don’t most businesses have predictable busy/slow days of the week? My bank is much busier on Friday afternoon than it is on Tuesday morning.

  4. Virginia says:

    Another question: why not run you OR on a 24 hour basis? The savings would be huge, since half of your physical plant is idle nights and weekends. Plus, you could price it like they do flights: rush hour time slots are more expensive than the 10 pm flights.

    Also, I am betting that there are some doctors and nurses that prefer alternate shifts where they can manage their schedule better.

    Illness does not take a break because it is the weekend or past 5. Why do hospitals? The American obsession with Monday through Friday, 8 to 5 is antiquated.

  5. Ted says:

    Agreed with Virginia, illnesses do not take a break, and they just keep spreading and doing more damage the more you wait.

    Right now waiting on an appointment for what I suspect and I am afraid is a bacterial infection. Even though I have been trying to get one since Thursday.

    I don’t understand why they don’t ever have any appointments available on the weekends. Why can’t they have people with an alternate friday & saturday or sunday & monday weekend.