The nature of weekends have changed over the years. Fifty years ago pretty much everything stopped on a Sunday. If you went into the centre of a town it would be eerily quiet – unlike today.
The same was true in hospitals.
From Friday evening to Monday morning patients were basically suspended in a care bubble. Nurses, of course, continued to deliver nursing care but other allied healthcare services– physiotherapy, occupational therapy, investigations and the like – were adjourned for two days. Nothing was started over the weekend – things waited for the magic of Monday morning.
“Nothing was started over the weekend – things waited for the magic of Monday morning”
There have been some moves away from this clear-cut five days on, two days off system in recent years, but unlike town centres, there is still certainly the “weekend effect” in hospitals.
If we started designing health services from scratch would we think it sensible to call a halt to the care pathway a patient was following and take two days off? Would we leave expensive equipment idle for 48 hours? Is it a good plan for someone with a stroke to have speech therapy and mobilisation daily for five days and then have two days off? Or for a new treatment that needs to be started or changed to wait for more staff to arrive at the beginning of the week?
“Is it a good plan for someone with a stroke to have speech therapy and mobilisation daily for five days and then have two days off?”
Of course sometimes care has to be delivered at the weekend as a result of accidents and emergencies. However the “weekend effect” means that, for example, anyone who needs unscheduled surgery at the weekend can expect poorer outcomes and a longer hospital stay.
Researchers have identified five resources that would mitigate against the “weekend effect”. And not surprisingly top of the list is more nursing staff. The other four elements are full implementation of electronic medical records, inpatient physiotherapy, supported discharge programmes and pain management programmes.
Considering the cost of inpatient care it does make sense to adopt a seven-day approach. Patients will get better quicker and outcomes will be improved. But to achieve this, of course, we need more nurses – and those nurses to be compensated for working weekends when their friends and families are not.
Out-of-hours payments are the only fair way to run such a system.