Trauma center patients treated after hours or on weekends have no difference in mortality rates
Research Activities, July 2011, No. 371
Patients with various medical and surgical conditions may not have the best outcomes when they are seen after normal business hours or on the weekends. When this happens, it is called the "weekend effect." Patients with heart attack and stroke are particularly vulnerable to this phenomenon. However, a new study of injured patients treated at a Level 1 trauma center found no difference in mortality for patients seen after hours or on weekends.
This finding may be due to the fact that Level 1 trauma centers must be fully staffed and ready for patients at all times, suggest the University of Pennsylvania School of Medicine researchers. Their study included 4,382 patients treated at a Level 1 trauma center in Philadelphia over a 3-year period. A third of these (34.0 percent) arrived over the weekend, while another 23.3 percent were seen during the overnight shift.
Overall, patients who arrived during weekends were no more likely to die (5.2 percent) than patients seen on weekdays (5.3 percent). Similarly, there was no significant difference in mortality rates between patients arriving overnight (4.4 percent) compared with those treated during the day (5.5 percent). These findings were consistent even for the most severely injured patients. There were also no differences between day versus night/weekend patients in terms of the length of time spent in the intensive care unit, the number of days on a ventilator, or the total time spent in the hospital.
Brendan G. Carr, M.D., M.A., M.S., and colleagues believe lessons can be learned from this study and applied to other time-sensitive conditions, including cardiac events, where outcomes are different on nights/weekends. They suggest developing a category system based on emergency care capabilities, improving staffing requirements, and implementing quality improvement programs to lessen negative outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (HS17960).
See "Does the trauma system protect against the weekend effect?" by Dr. Carr, Peter Jenkins, M.D., Charles C. Branas, Ph.D., and others in the November 2010 The Journal of Trauma Injury, Infection, and Critical Care 69(5), pp. 1042-1048.