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New evidence shows why the hospital 'weekend effect' is so dangerous

Several factors, ranging from the time of year to the day of the week, can affect how well a patient does in the hospital, a new study finds.
/ Source: TODAY

Several factors, ranging from the time of year to the day of the week, can affect how well a patient does in the hospital.

A study published on Monday found that people checking into the hospital over the weekend were more likely to die within 30 days compared to those who were admitted during the week. It’s been dubbed “the weekend effect” and it’s been documented in other studies over the years.

But this new study looked at a large number of admissions and was international in scope. Researchers looked at data from almost 3 million admissions between 2009 and 2012 from 28 metropolitan teaching hospitals in England, Australia, the U.S., and The Netherlands, according to the report published in BMJ Quality & Safety.

They found that the risk of dying within 30 days was higher for emergency admissions on weekends in three out of the four countries: it was 8 percent higher in England, 13 percent higher in the U.S., and 20 percent higher in six Dutch hospitals.

And in Australia, there was a noticeable effect when researchers looked at deaths occurring within 7 days of admission.

Even worse, there was a Friday effect in the Dutch hospitals, with the risk of death 33 percent higher if a patient was admitted on a Friday than on a Monday.

Though the study did not tease out reasons for the “weekend effect,” the researchers speculated as to possible causes.

“We were unable to look at staffing or access to services within the hospital,” said study coauthor Paul Aylin, a professor of epidemiology and public health in the School of Public Health at Imperial College London. "Our own work around stroke care in the UK suggests that patients admitted at the weekends are less likely to get a same day brain scan, less likely to get clot-busting treatment and have worse outcomes across a range of indicators.”

The study showed the risk of death for planned surgery is very low — a fraction of a percent, so patients shouldn't worry too much. But Aylin says, "if I were a patient, I would be interested to know my hospital’s policy on staffing levels and senior consultant cover over the weekend,” he said.

Clearly, if you have an emergency, you need to check into the hospital right away whether it’s a weekend or not, said NBC News Medical Contributor Dr. Natalie Azar.

Azar agrees staffing levels may play a role.

“If you come in with a cardiac arrhythmia, pulmonary embolism, something life threatening that requires an intervention, the hospital might just not be staffed as well as it is during the week,” she told TODAY.

Weekends may not be the only problem, although studies about a possible “July effect" are mixed.

“The whole basis of this is that the academic year for medical trainees starts on July 1, and that means that every year from June 30 to July 1 there is a whole switch over of doctors who are taking care of you,” she said. “They’re getting used to new electronic medical records. They’re inexperienced. But I should say that there is a lot of supervision that still happens. So you may not want to schedule something elective on July 1.”

Give it a couple of weeks for things to shake out, Azar counsels.

Another factor to consider: teaching hospital or not.

“If you are admitted and getting a procedure done in what’s called a university academic teaching hospital you have to assume there will be residents who are taking care of you as well as the attending physician and this is very relevant when it comes to surgeries,” Azar said. “There have been many studies that have looked into the safety comparing these two kinds of hospital systems and it actually looks like, in some cases, that hospitals that have residents actually perform better than the hospitals that don’t.”

Her advice: Bring an advocate, no matter when you go.

“You want to have either a family member or a friend with you, somebody to prep questions and take notes,” she explained. “You’re in a stressful situation when you are in the hospital. You may not be taking everything in.”

And be prepared for the unexpected.

“Things can always go wrong,” Azar said. “It doesn’t matter what age you are when you are admitted to the hospital you should always have something called an advance directive as well as a health care proxy.”