The Weekend Effect: What Day You Need The Hospital Matters

February 15, 2023

By Katherine Bolton Wanrooy

Americans are nonstop.   Overflowing ‘to-do’ lists and days that are jam-packed are societally accepted and expected.  While we’re busy running from one thing to another and juggling endless demands, if you’re in the hospital, on the weekend, it may look different than this busy picture.  In many hospitals, on the weekends, the pace, urgency or just plain time to go around may not be the same as it is during the weekdays.  It doesn’t always mean that there are less skilled clinical staff, it simply may mean there are fewer of them available as well as fewer testing options available on the weekends.

On weekdays, in many hospitals all across the country, patients are offered a wide-range of testing and procedures necessary, are kept on close watch by numerous experienced healthcare providers and are given follow-up procedures or instructions quickly.  For example, if you present to University of Michigan with a STEMI, you’re likely to have a balloon procedure within 90 minutes of your arrival. 

The possible differences in hospital care over the weekend have been examined and extensively researched.  The phenomenon is referred to as “The Weekend Effect”.  This describes the increased mortality rates or complication rates, which leads then to mortality, due to fewer resources available on the weekend.

There are numerous factors contributing to The Weekend Effect.  It matters why each patient arrives at the hospital, which hospital and philosophies that drive the numbers of physicians and nurses available on the weekends.  It also matters how long a patient has waited to seek medical help.  If a patient is having the most serious type of heart attack, a “STEMI”—An ST-elevated myocardial infarction, and doesn’t seek medical help immediately, heart tissue may be dying while the patient is debating. 

Extensive studies on The Weekend Effect have been conducted around the world and findings differ depending on where you are and what you present with. 

This being said, study after study from the US to the UK to Japan come to similar conclusions regarding the weekend effect.  Time and time again, cases regarding myocardial infarction (heart attack) or cerebral infarction (stroke), in particular, produce significantly higher mortality rates for those admitted on the weekend.  There are, of course, studies that also support equal risk of mortality on the weekend versus the weekday, and this is an ongoing research area.  The most important aspect is that it is continually being studied.  If unbiased studies are being conducted for the true benefit of patients, the weekend effect has a greater chance of being reduced, but is it?

The National Health Service (NHS) in the United Kingdom has, within the last four years, suggested a detailed implementation of a plan to ensure that all patients are treated equally when arriving at the hospital, regardless of the day of the week.  Unfortunately, cost is an enormous factor in healthcare and treatment of The Weekend Effect is not immune.  There are many skeptics on where the money will come from.  Still, there are many that are very passionate about its need and have proposed that seven-day equivalent health care coverage be implemented in the United Kingdom by the year 2020.  The studies show the need, and now it is up to lawmakers in the UK to support it and find the money or keep the need going.  Study after study have proven that patients have an increased risk of death when they are admitted to the hospital on a Saturday or Sunday across the board.  Data sets such as the NIS (Nationwide Inpatient Sample) have been studied thoroughly to support the weekend trends on mortality.  Agencies such as The Joint Commission showed no signs of requiring hospitals to provide completely equivalent care on the weekends as is provided during the week.

For example, a patient presenting to the hospital after 5:00 pm on a Friday with acute myocardial infarction receives less opportunity for percutaneous coronary intervention (PCI)—an invasive, life-saving method that the same patient would receive, in some cases within a 90-minute threshold during a weekday.  The same patient admitted on the weekend, would potentially have to wait until Monday to receive this procedure or merely wait over the established 90-minute window due to fewer physicians and/or resources.    

“The average number of days between admission and catheterization was significantly higher for patients admitted on weekends in all four calendar periods” (New England Journal of Medicine)

Every hour or day that goes by in between the event and the procedure, increases mortality rate not only during the hospital stay, but within 30 days following the event as well as up to a year after.  Those first few minutes, hours and days after a myocardial infarction are essential to decreasing mortality.

“Primary angioplasty for STEMI during nighttime has been associated with an increased failure rate and higher 30-day mortality.  A study of 33,647 patients undergoing angioplasty for STEMI found that 54% were treated at night and on weekends. These patients had longer door-to-balloon times than patients presenting during

daytime and weekdays (116 vs. 95 min) and had a significant increase in adjusted in-hospital mortality.”

(www.semanticscholar.org)

In a Stroke publication by the American Heart Association, a 2009 study entitled:  Influence Of Weekend Hospital Admission On Short-Term Mortality After Intracerebral Hemorrage found that those admitted for a stroke on a Saturday or Sunday were at approximately 12% greater risk of dying within one year.  Fewer interventional procedures available to be performed on the weekends was one of the main factors in this.     

The actual weekend days aren’t the only high-risk days.  Mondays have their own challenges due to the overspill from the weekend.  The best days for the best care and/or surgery?  Tuesday, Wednesday, Thursday.  Teaching hospitals also had higher rates of The Weekend Effect. 

Whether a physician or patient or family member or nurse, we all will either need this type of healthcare, or know someone who will.  No matter what day of the week we all deserve equivalent care and the peace of mind knowing that it’s there.       

2009, Influence Of Weekend Hospital Admission On Short-Term Mortality After Intracerebral Hemorrage.  Stroke.  American Heart Association.  Crowly, Yeoh, Stukenborg, Medel, Kassell, Dumont.

http://stroke.ahajournals.org/content/strokeaha/40/7/2387.full.pdf

http://stroke.ahajournals.org/content/strokeaha/40/7/2387.full.pdf

https://www.nejm.org/doi/full/10.1056/nejmoa063355

http://www.bbc.com/news/health-34150672

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802773/

https://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp

https://www.england.nhs.uk/wp-content/uploads/2013/12/evidence-base.pdf

https://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/

https://www.sciencedaily.com/releases/2018/03/180303095447.htm