Paul Levy: Hospital Complications on the Weekend
Monday, March 05, 2012
Paul Levy, GoLocalWorcester MINDSETTER™
In a 2007 study, authors examined New Jersey hospital discharge data for acute myocardial infarction (heart attacks) and found that patients admitted on the weekend had higher mortality and were less likely to receive invasive treatment.
Across the Pond in the United Kingdom, another analysis, published in 2010, looked at more than 4 million emergency department admissions. Investigators discovered that patients admitted during the weekend experienced 10% higher odds of death. “The authors estimate that nearly 3400 excess deaths during 2005-2006 could be attributed to weekend care, which exceeds the number of deaths from road accidents in Great Britain in 2006—an admittedly crude but striking comparison.”
And, most recently another UK study analyzed more than 14 million admissions to the National Health Service Hospitals in England. Investigators found a higher rate of 30-day deaths for weekend admissions compared to midweek ones. “Of note, there was a reduced risk of deaths occurring on the weekends themselves; the risk came on subsequent days.”
What are we to make of this? If you are experiencing chest pains on Saturday night, should you wait till Monday to go to the hospital? Surely not! Your risk of dying by not going to the hospital is dramatically higher than if you do go.
But, I’d like to offer even more reassurance, comfort that comes from changes in hospital procedures and standards that have been put in place since these studies were conducted.
One of the most important relates to emergency treatment for heart attacks. All hospitals in the US now are expected to meet a very high standard of care when patients show up with chest pains. For many such patients arriving at the ER, you are quickly whisked up to the cardiac catheterization lab, where doctors insert devices into your arteries to diagnose the cause of the problem and, if appropriate, insert a “balloon” to clear blockages. The technical term for this is percutaneous (i.e., “under the skin”) coronary intervention.
Time matters in these cases, because delays result in more damage to your heart muscle. Relieving the blot clot can restore blood flow to the heart, minimizing that damage, and improving the likelihood of surviving. It is because of this importance that The Joint Commission -- the body that accredits hospitals -- has set a standard for opening blocked arteries with catheterization within 90 minutes of a patient’s arrival at an emergency room in a hospital. The hope is to achieve this goal at least 90% of the time.
Achieving this goal is not easy, and hospitals focus hard on it. First, they need to quickly diagnose the heart attack. Second, the patient has to agree to have a heart catheterization and to be transported to the cath lab. Third, the procedure has to be carried out accurately and carefully.
As hospitals came to understand the importance of this procedure over the years, they devoted resources to improving their workflow. For example, Massachusetts General Hospital reports: “From the time the MGH began its initiative to enhance the door-to-balloon time in 2002, the median door-to-balloon time has fallen more than 50 percent. Recent results show that ninety-four percent (94%) of MGH heart attack patients have a door-to-balloon time of less than 90 minutes. “
Because this metric is easily measured and reported to The Joint Commission, you will also find it available on many hospital websites. For example, U. Mass. Memorial Medical Center in Worcester reports results that are superior to the national standard, averaging 50 minutes for door-to-balloon time.
In fact, if you compare most hospitals on this metric, you can see that staying local and getting to a hospital quickly is a sound strategy. For example, if you live in Central Massachusetts, St. Vincent’s Hospital reports 96% achievement with the target and U. Mass. Memorial reports 94%, equivalent to the results reported by MGH.
So, weekend or weekday, when you have an emergency, don’t delay. They are ready for you.
Paul Levy, former CEO of Beth Israel Deaconess Medical Center, is an advocate for patient-driven care who writes a blog about health care issues entitled Not Running a Hospital.
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