On weekends, many services may be less available or not available at all in the hospital, from interventional radiology to physical therapy. If patients have fewer contacts with different hospital personnel, it is more likely that subtle early signs of acute problems will go unnoticed until later.
“At my hospital, the interventional radiology [IR] department is not open 24 hours,” says Erica Grabscheid, MD, associate director of the hospitalist program at Beth Israel Hospital in New York City. If a peripherally inserted central catheter needs to be placed on the weekend but IR is not available, the patient may have to wait until Monday morning. Alternatives for the hospitalist, Dr. Grabscheid says, are to become skilled at line placement or to collect data for the hospital’s administrators on the costs of not having 24-hour IR.
Jeffrey Robinson, MD, hospitalist group leader for Intermountain Medical Center in Salt Lake City, Utah, believes staffing is an essential part of the equation. He says Intermountain Health has made a commitment to do what’s necessary for quality patient care—including adequate staffing. “Every time we feel we’re stretched, we add more hospitalist shifts, including weekends and holidays. I feel we give good patient care from the physician side. Obstacles have more to do with ancillaries, but we’ve made great progress in addressing these, as well.”
At one time, interventional radiology only was available in the hospital five days a week, Dr. Robinson notes. “You couldn’t get feeding tubes placed or certain other interventional procedures. But with the commitment of radiology and the hiring power of Intermountain Health, we now have 24-hour availability. MRIs have been harder to cover after hours, but there is now an on-call team for MRIs.”
In each case, hospitalists were important advocates for expanding the hours of availability, Dr. Robinson says: “We needed to gather data and look at results for patients staying over the weekend. We also got expanded case management, so that nursing home placements could happen on Saturdays and Sundays.” TH
Larry Beresford is a medical writer based in California.
References
- Peberdy MA, Ornato JP, Larkin GL, et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008; 99(7):785-792.
- Kostis WS, Demissie K, Marcella SW, Shao YH, Wilson AC, Moreyra AE. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med. 2007; 356(11):1099-1109.
- American Heart Association. Deaths higher in stroke patients who enter hospital at night, weekends. Available at www.sciencedaily.com/releases/2008/02/080220161720/htm. Accessed March 13, 2008.