Recalibrating Norms regarding Weekend Hospital Stays

Kaiser Permanente is taking steps to recalibrate the norms surrounding patient care provided on weekends according to a recent article by Robert Pearl, M.D., CEO of The Permanente Group. Separate studies from Canada, the U.K., and the U.S. indicate that certain outcomes are worse for patients who are admitted to the hospital on a weekend.

Regardless of the day, being in the hospital puts patients at risk for contracting other illnesses. Furthermore, it disrupts sleep and may exacerbate stress and cause delirium. Non-critical patients admitted over the weekend frequently have to wait until Monday for diagnostic tests. Days spent in limbo prolong a patient's exposure to these risk factors and may allow the presenting illness to worsen.

During the week, all diagnostic and interventional services are open. On the weekend, many of them shut down except when staff members are called in to care for a life-threatening problem. The on-call staff understands that when a patient’s life depends on their expertise, they need to stop what they are doing and drive to the hospital. But the culture of medicine supposes that making a stable patient wait until Monday won’t be a problem. As a result, the pace of medical care for patients on the weekend slows from a run to a walk.

Because patients cannot choose the day of the week on which to experience an acute health incident, the solution must involve a change in the "culture of medicine." Dr. Pearl suggests that a more even distribution of staff over all seven days allows for complete teams, available to diagnose and treat non-urgent patients in a timely manner, even on weekends. Furthermore, working to standardize rounds all seven days of the week, as opposed to allowing for a more relaxed "change of the guard" on weekends, greatly improves the standard of care for weekend patients.

It’s no surprise that having more doctors and technicians on hand over the weekend improves patient outcomes. And maximizing the performance of high-capital facilities seven days a week isn’t new to business leaders. But making this change in expectations will clash with medical culture.

Although this shift in norms may seem like a reasonable fit for medical professionals, whose career choice indicates a desire, at some level, to help people, it potentially clashes with another norm: the weekend norm. For many people in the U.S., weekend time is a precious commodity, spent relaxing, recreating, and bonding with family. Dr. Pearl acknowledges that the external pressures to improve patient care and to increase cost-effectiveness may not be enough; incentives may be a necessary catalyst to affect this critical change.

Expanding weekend hours and raising expectations will impact the lives of physicians and staff in ways they are likely to resist. But with reduced payments from Medicare and increasing demands for lower prices through the health insurance exchanges, expectations are going to change.Since these agreements will be inconvenient for people, the hospital could provide financial incentives to physicians and staff for improved quality outcomes to ensure the changes are being carried out effectively and collaboratively.And once hospitals change their practices, the real winners will be patients and their families.

Tile Image: Brian Clift

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