23 Mar ‘Weekend Effect’ Boosts Trauma Patients’ Survival Chances

HealthLeadersMedia.com | Trauma patients who’ve been hurt in car or bike crashes, shot, stabbed, or suffered other injuries are more likely to live if they arrive at the hospital on the weekend than during the week, according to a study from the University of Pennsylvania School of Medicine.

The research, published in the current issue ofArchives of Surgery, also shows that trauma patients who present to the hospital on weeknights are no more likely to die than those who present during the day, contrasting previous studies showing a so-called “weekend effect” in which patients with emergent illnesses such as heart attacks and strokes fare worse when they’re hospitalized at night or on weekends.

The study found that the trauma system’s unique organization and staffing appears to serve as a built-in protection for these critically injured patients, and may provide a roadmap for restructuring and coordinating emergency care.

“Whether patients have an emergent illness or a severe injury, the common denominator is time. Patients must rely on the system to quickly get them to the place that’s best prepared to save their lives,” said Brendan G. Carr, MD, an assistant professor in the departments of Emergency Medicine and Biostatistics and Epidemiology, and a lead author of the study. “Trauma systems have been designed to maximize rapid access to trauma care, and our results show that the system also offers special protection for patients injured during periods that are known to be connected to worse outcomes among patients with time-sensitive illnesses.”

The researchers studied 90,461 patients who were treated from 2004 to 2008 at Pennsylvania’s 32 accredited trauma centers. About 25% of the patients presented to the hospital on weeknights — defined as 6 p.m. to 9 a.m. Monday through Friday — and about 40% arrived on weekends — 6 p.m. Friday to 9 a.m. on Monday. Neither the weekend or night patient groups experienced delays for crucial brain or abdominal surgeries often required for trauma patients, compared to weekday patients, the study found.

Unlike most other medical and surgical specialties – in which staffing and resources vary on nights and weekends – trauma centers are required to have round-the-clock resources for emergency medicine, radiology, surgery, and post-operative intensive care immediately available 24 hours a day, seven days a week, 365 days a year.

The report suggests that the greater odds of survival on weekends may be influenced by hospital scheduling. Since elective surgeries are typically not performed on weekends, there is less competition for practitioners’ time, operating rooms, blood bank, pharmacy and other hospital resources.

Despite the indication that trauma patients may, overall, be safer during off hours, the findings revealed that both weeknight and weekend presentation was associated with longer ICU stays, and those who came to the hospital on weeknights were more likely to have a longer hospital stay overall than those who were admitted on a weekday. The report said this may be due to hospital factors not entirely related to the patient’s condition, including greater bed availability because few elective admissions and surgeries occur on weekends.

“It is unrealistic to think that all hospitals can be fully staffed to provide optimal care for all time-sensitive conditions all of the time, so our challenge is to develop an integrated system of emergency care for unplanned — but inevitable — critical illness,” Carr said. “The trauma system has a plan of care in place long before we ever need it, and it offers many lessons for the remainder of emergency care.”

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