Friday, July 23, 2004

Kevin provides a link and commentary to this article concerning the difference between weekday and weekend utilization of certain diagnostic and therapeutic tests. The author of the study found that fiberoptic bronchoscopy, MRI, upper endoscopy, echocardiography, V/Q scanning, and cardiac catheterization were more likely to be performed on weekdays than on weekends. The study's author (as well as Kevin) opine that LOS could be shortened and outcomes improved if weekends could be treated like weekdays.
With the caveat that I don't have access to the full article, here are my thoughts:
There is a difference between "urgent" and "emergent" procedures. The definition of urgent in this paper by my reading seems to be "procedures performed on hospital inpatients". Of those listed I would consider V/Q scanning to be more urgent than the others listed. The others can fall into either camp.
The "well that's a Canadian hospital" argument doesn't apply since many of those services are rarely available in American hospitals.
As one who performs procedures from time to time I have to deal with the short staffing of hospitals on the weekends. Not only of nurses and techs but the unavailability of other physicians. This affects things in two ways:
There is less backup in case something goes wrong during or after a procedure. A patient that develops airway difficulty after an upper endoscopy done during business hours has many people with the skills and equipment to handle the problem available to tend to them. Over the weekend there may only be one person available to assist, and that person may not even be in house.
Physician availability is less. During the week if I am on call and doing an elective or urgent procedure and something comes in the ED, I can ask one of my partners to lend a hand. During the weekend they may not be available. That places limits on what can, or should be done. Imagine the situation of a surgeon performing a lap chole over the weekend and a ruptured AAA presents to the ED. The AAA patient expires, if the surgeon is sued what sort of defense does he have for not attending to an emergent patient while he performs what is essentially an elective procedure?
But what if the hospital was fully staffed? Given the current nursing shortage and the premium that would have to be paid to staff to work the weekend, to give up time with their friends and family, would likely surpass any LOS savings that could be achieved. The famous Baylor Plan pays nurses the equivalent of 40 hours for 24 hours of weekend work. And what of the physicians? Given the current enthusiasm for resident work restrictions and the growing emphasis on family and lifestyle issues among physicians of all levels, the likelihood of "every day a weekday" is remote at best.
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