Injured patients fare slightly better on weekends

NEW YORK Tue Mar 22, 2011 12:28pm EDT

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NEW YORK (Reuters Health) - Injured patients who are treated by trauma teams at hospitals are less likely to die when they are admitted on weekends versus weekdays, new research from Pennsylvania shows.

The results contrast with studies of intensive care units and stroke patients that have revealed a "weekend effect," in which patients landing in the hospital from Friday night to Monday morning are more likely to have complications or die (see Reuters Health reports, July 6, 2010 and November 1, 2010).

The researchers looked at records from Pennsylvania hospitals, including more than 90,000 patients over a 5-year period. All the patients came in with an injury, for instance from a gunshot or car accident.

"We expected to see no difference" between weekdays and weekends, Dr. Brendan Carr, the lead author of the study, told Reuters Health.

That's because trauma centers are required to have the same number of surgeons, nurses and other responders available 24 hours a day, 7 days a week.

Other departments typically have fewer doctors on hand overnight and on the weekends, which is one of the reasons for the weekend effect.

At first glance, it didn't seem to make much difference when an injured patient was admitted: About seven out of every 1,000 patients who came in -- whether during the week or on the weekend -- died.

But when the team accounted for how bad the injuries were, how many other health problems the patients had, and how old they were, it turned out that people were slightly less likely to die if they came in after 6:00 PM Friday and before 9:00 AM Monday.

If staffing in trauma units is the same all the time, why did patients actually do better if they came in on the weekend?

"The hospital is fundamentally different" at off-hours, said Carr, a professor at the University of Pennsylvania School of Medicine.

"The operating room is empty. The blood bank is not distracted by other activities," for instance, which could free up hospital resources on the weekend and possibly explain the difference.

Carr's team used data from the Pennsylvania Trauma System Foundation, which accredits the state's trauma centers. Their study was funded by a grant from the federal Agency for Healthcare Research and Quality and was published in the Archives of Surgery.

Dr. John Kostis, chairman of the Department of Medicine at UMDNJ-Robert Wood Johnson Medical School in Piscataway, New Jersey, has done research on the weekend effect in heart attack patients (see Reuters Health report, March 17, 2007).

He told Reuters Health that other hospital departments could learn a lot from the way that trauma teams function.

"It would be a great idea to organize a (heart attack) system," similar to states' trauma networks, which have specially trained teams available at all times at designated hospitals, Kostis said.

"It makes a difference having an experienced physician available at all times," Dr. David Shulkin, the CEO of Morristown Memorial Hospital in New Jersey, told Reuters Health.

"It's a model that probably makes sense across the hospital," Shulkin said.

But mimicking the trauma unit in each hospital department with a fully staffed, round-the-clock team could prove to be expensive.

"And the sheer lack of experienced people, that's another barrier," Shulkin said.

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