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More nurses among key factors to cutting weekend deaths


More nurses and electronic medical records are among the five key factors that help overcome the “weekend effect” in hospitals, according to US researchers.

It is well-established that patients who undergo surgeries on weekends tend to experience longer hospital stays and higher mortality rates and readmissions.

The trend is currently one of the key drivers behind a major government policy to make the NHS a “truly seven-day service”.

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

Study authors

The authors of a US study say they have, for the first time, identified five resources that can help hospitals overcome the so-called “weekend effect”.

The five factors identified are an increased nurse-to bed ratio, full adoption of electronic medical records, inpatient physical rehabilitation, and a home-health and pain management programme.

The findings suggest improved staffing, inpatient and aftercare resources “can play an important role in ensuring patients are not disadvantaged by being admitted to the hospital on the weekend”, said the researchers from Loyola University in Chicago.

Several reasons have been proposed to explain the weekend effect, including reduced staffing and resources and fewer experienced doctors and nurses working on weekends.

The researchers suggested that boosting hospital resources before, during and after surgery could overcome the weekend effect.

They tested their hypothesis in patients undergoing three types of urgent surgeries that could not be delayed until weekdays – appendectomies, hernia repairs and gall bladder removals.

The researchers examined records of 126,666 patients at 166 Florida hospitals over a five-year period from 2007-11.

The weekend effect was defined as having longer length of stays on the weekend than during the week.

During the five years of the study, published in the journal Annals of Surgery, 21 hospitals developed a weekend effect and 41 hospitals experienced a weekend effect for all five years.

The researchers were most interested in 17 hospitals that were able to overcome the weekend effect.

They examined 21 hospital resources, and after controlling for patient characteristics, identified five resources that helped to overcome the weekend effect:

  1. Hospitals with increased nurse-to-bed ratios were 1.44 times more likely to overcome the weekend effect. Hospitals that overcame the weekend effect had a median nurse-to-bed ratio of 1.3, compared with a nurse-to-bed ratio of 1.1 among hospitals with a persistent weekend effect
  2. Hospitals with home health programmes were 2.37 times more likely to overcome the weekend effect.Skilled caregivers checked on patients after they were discharged, providing wound care, administering medications, etc
  3. Hospitals that fully adopted electronic medical records were 4.74 times more likely to overcome the weekend effect. Only 12.2% of hospitals that had persistent weekend effect had fully adapted electronic medical records, compared with 40% of hospitals that overcame the weekend effect
  4. Hospitals with inpatient physical rehabilitation programmes were 1.03 times more likely to overcome the weekend effect. Patients were identified who required additional physical conditioning prior to discharge or need extra resources at home
  5. Hospitals with pain management programmes were 1.48 times more likely to overcome the weekend effect. Seventy percent of hospitals that overcame the weekend effect had pain management programmes, compared with 49.3% of hospitals that had persistent weekend effects

Readers' comments (5)

  • if we are to have more nurses, then nurses need to be seen as valued

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  • I totally agree with the above comment and where are these extra nurses and resources going to come form.........

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  • Absolutely - the answer is more nurses whether in the US or here. With the latter: more nurses, but not from outside the EU unless we can pay > £35K, not from agencies, not that we have trained (not enough of them) and not that we have persuaded to return from well earned retirement (1% maximum when inflation runs at 2%). The challenge in the NHS is to increase nurses available without breaking these self imposed restrictions
    If the secretary of state pulls that one off, perhaps a career in magic beckons?

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  • more people die at the weekend [ mortality % rates] because the proportion of sick people is higher at the weekend. most minor surgery day cases etc are done in the week. The statistic are being used to bring in 7 day working contracts for all staff especially the consultants /junior doctors

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  • Amazing how people skew the data and then hand it to the media to turn the gullible public against the NHS.

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