Don’t get sick or injured on evenings and weekends

The Informed Patient - WSJ.com
Patients suffer higher rates of death, complications and medical errors when they are treated during thinly staffed off hours. Now, some hospitals are taking steps to improve safety and reduce their own legal liability from mishaps.

Institutions that long relied on having doctors on call at home are hiring physicians known as nocturnists, who work only night shifts. Some hospitals have begun staffing intensive-care units round-the-clock with critical-care specialists who do double-duty coping with a crisis anywhere in the hospital. And new policies are being put in place to improve communications at the hand-off between the day and night shifts.

“People get sick 24 hours a day, but there is a stark discrepancy in the quality of care on nights and weekends” when 50% to 70% of patients may be admitted, says David Shulkin, chief executive of New York’s Beth Israel Medical Center. Dr. Shulkin has been making midnight rounds at his hospital on a regular basis to evaluate the quality of care and the need for additional staffing. In a recent editorial in the New England Journal of Medicine, he called on counterparts at other hospitals to do the same.

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The risks of seeking after-hour care are well documented. Recent studies show higher death rates for patients who arrive at the hospital with strokes after hours. This is also the case for patients who have a cardiac arrest at night when they are already in the hospital. And Stanford University researchers who examined close to five million hospital admissions in three states reported last year that rates of complications are significantly higher on weekends for surgeries including vascular procedures and obstetrical trauma during cesarean sections.

Night-shift nurses often have bigger patient loads than nurses during the day, and may feel under pressure to take unsafe shortcuts. David Longnecker, an official at the Association of American Medical Colleges in Washington, D.C., says he was in a New York hospital for a diagnostic procedure recently. A nurse came in to change the bag on his IV medications twice during the night, he says. Even though he was awake, the nurse didn’t ask him to identify himself or check the name on his wristband against the medication, which is standard procedure. “Fortunately, there was no bad outcome, but it was a perfect setup for a major accident,” Dr. Longnecker says.

This isn’t particularly surprising. Actually one of the things that really frustrates me is the availability of some doctors - 3-4 day work weeks, etc.

I can’t really blame the system. 1) People generally don’t want to work those hours. 2) It costs more and isn’t profitable.

Another reminder to never get sick or injured.