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More nurses among five factors key to improving weekend outcomes

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Recruiting more nurses and adopting the use of electronic medical records are among the resources identified by researchers as necessary to overcome “weekend effect” in hospitals.

It is well established that patients admitted or undergo surgery at the weekend tend to experience longer hospital stays and higher mortality rates and readmissions.

Making the NHS a “truly seven-day” service one of the Conservative’s manifesto pledges, and the idea is also popular with Labour and the Liberal Democrats health spokesman.

Several reasons have been proposed to explain poorer outcomes at weekends, including reduced staffing and resources and fewer experienced doctors and nurses working on weekends.

“Specific hospital resources can overcome the weekend effect seen in urgent general surgery procedures”

Study authors

Researchers in the US now say they have, for the first time, identified five resources that can help hospitals overcome the “weekend effect” for patients that have undergone a surgical procedure.

Top of their list is increased nurse-to-bed ratios. As well as more nursing staff, the researchers identified full adoption of electronic medical records, inpatient physical rehabilitation, home-health programmes and pain management programmes.

The study authors, from the Loyola University Health System, said: “Specific hospital resources can overcome the weekend effect seen in urgent general surgery procedures.”

They hypothesized that boosting hospital resources before, during and after surgery could overcome the weekend effect. They tested their hypothesis in patients undergoing appendectomies, hernia repairs and gall bladder removals.

They examined records of 126,666 patients at 117 Florida hospitals. Of the 21 hospital resources researchers examined, five were found to help overcome the weekend effect after controlling for patient characteristics.

Hospitals with increased nurse-to-bed ratios were 1.44 times more likely to overcome the weekend effect.

Seventeen hospitals that were judged as having overcome the weekend effect had a median ratio of 1.3 nurses per bed, compared with a ratio of 1.1 nurses per bed among 41 hospitals with a persistent weekend effect.

Hospitals with home health programmes that checked on patients after they are discharged were 2.37 times more likely to overcome the weekend effect.

In addition, hospitals that fully adopted electronic medical records were 4.74 times more likely to overcome the weekend effect.

Meanwhile, hospitals with inpatient physical rehabilitation programmes were 1.03 times more likely to overcome the weekend effect, and those with pain management programmes were 1.48 times more likely to overcome the weekend effect.

The study findings were presented at a meeting of the American Surgical Association in San Diego on 25 April. Researchers plan to conduct a follow-up study of hospitals in California.

The current findings are expected to be published in the journal the Annals of Surgery in future.

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Readers' comments (1)

  • It's common sense....but you are going to have continue to pay a shift premium to staff if you expect them to work unsocial hours. Nobody is going to work weekends and evenings for standard rate of pay - why should they? Trusts may balk at this, but it's cheaper than keeping expensive resources unused for 2 days out of 7.

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