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.
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.
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.
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