Sunday, September 20, 2015

Weekend effect in hospital

In Japan, we are in the "silver week." The five sequential days from 19 to 23 are holidays. It is enjoyable for me, but may be a nightmare for patients.

Gigazine described the "weekend effect" in hospitals. It means that mortality rate in hospitals is raised in a weekend.

Gigazine: Weekend effect (in Japanese)

It has been well known not only empirically but also statistically. You can imagine that limited provision of healthcare at weekends affects the quality of case for patients. In most hospitals, there are only a few doctors as well as nurses staying on duty at the weekend. Several medical devices are not available at the weekend due to deficiency of staffs and needs for rest. In addition, accidents are likely to occur because many people go out at the weekend. This trend is universal.

The BMJ: Analysis Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

Mail Online: Patients more likely to die at the weekend: Global study reveals higher mortality rates among people who go under the knife on a Saturday afternoon

The NHS in England estimated that 11,000 patients were victimized by the weekend effect in a year. These cases are deemed as avoidable death. On the other hand, NHS seems to hesitate to commit this issue. The reason is obvious. Medical practitioners cannot be provided infinitely. If it wants to enrich the capacity of hospitals at the weekend, medical staffs at weekdays should be reduced, which is meaningless in the sense for preventing avoidable deaths.

The BBC: NHS Weekend: Action demanded over death risk

The situation is quite the same in Japan. Doctors on duty at the weekend are forced to sacrifice their holidays. In most hospitals, alternative holidays are not offered. When medical staffs are exhausted due to excessive work, the prevalence of medical incidents is increased. Substantially, the medical resource is limited.

Similarly, "September effect" is believed by medical practitioners. In September, new doctors just finished medical training enter the hospital. They are not familiar with the real medicine, and sometimes careless, unskilled, and lack experience. Skilled doctors should take care of them for a considerable amount of time, of course, it is necessary investment. Therefore, patients cannot be looked after enough.

In Japan, the academic year begins in April. And in my impression, medical incidents are likely to occur in April. You should avoid entering the hospital at the beginning of the academic year, if it is possible.

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