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.

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.