Many of us view the weekend as a time to recharge and get ready for a new week. But for some hospital patients, a weekend stay could mean exposure to a phenomenon called the “weekend effect.” Patients with Saturday or Sunday in their stays might be at risk for longer lengths of stay (LOS), greater complications and early mortality. Some of these risks are avoidable, however.

“While every organization is unique with different patient populations, a hospital can, through a detailed assessment, uncover elements that may be indicative of its weekend effect and take steps to address them,” said Aman Sabharwal, MD, senior principal at Vizient. “Staffing and resource availability may be contributing factors to the weekend effect.”

Pairing patient needs with resources

A hospital’s LOS and patient population data can offer a window into underlying causes of the weekend effect. "Look for patients with weekend stays who also had Monday procedures or diagnostic studies. And then look at which patient populations were most frequently involved, such as cardiac patients," Sabharwal said. 

The weekend effect impacts virtually every acute care hospital to some degree. Aligning LOS and patient data can give a hospital a clearer idea of where to allocate its staffing resources.

“If a hospital has a length-of-stay problem, for example, and the largest patient volume is cardiac patients, we’ll isolate which types of cardiac patients have an increased LOS, and then see what’s driving that. Maybe it’s that the hospital doesn’t offer cardiac stress tests on weekends,” Sabharwal said. “We would couple the quantitative data with qualitative, on-the-ground observations and interviews. With this combined information, we’d determine that the hospital could eliminate a percentage of excess avoidable days by performing cardiac stress tests on Saturday or Sunday.”

Hospitals often think that additional full-time hours must be added, but that’s not always the case, Sabharwal explained. Most hospitals currently provide diagnostic and interventional services, such as MRI and CT scans, GI endoscopy and cardiac catheterization, on a Monday-Friday schedule. It is based on weekday volume, which is higher than weekend volume. “We could consider different ways to staff those departments, after looking at the data and identifying certain types of treatment modalities, procedures or diagnostics that are delayed until Monday and its related increasing LOS,” Sabharwal said.

“Let’s use the echocardiography lab, for example. If we compare volume in a weekday cycle with staffing in the same cycle, we might see that between 4 p.m. and 7 p.m. on Tuesdays and Thursdays, there is not a significant volume of echocardiograms. Does the department need to be fully staffed until 7 p.m.? What if the department adopted a flexible shift schedule on certain days, and they reallocated certain hours to thereby staff a Saturday or Sunday? This arrangement would allow patients to be seen sooner, potentially be discharged before Monday and improve outcomes without adding full-time staff,” Sabharwal said.

In one recent example, the Vizient team, by working with a member hospital, adjusted staffing and hours in the cardiac stress lab to accommodate weekend hours without adding additional resources or compromising patient needs. This resulted in a one-day reduction in LOS for chest pain patients. The Vizient Clinical Database (CDB) can also provide members with the data to do a deeper dive and determine solutions that work best for the organization.

Uncovering physician coverage issues

Departmental staffing isn’t the only possible contributor to the weekend effect. Having the right level of physician staff coverage to meet demand on Saturday and Sunday is crucial, just like it is Monday through Friday. One hospital in the Northwest had decreased its physician staffing by half on the weekends. The belief was that weekends were synonymous with lower volumes, but that wasn’t the case.

“During the week, three or four hospitalist teams were each rounding on 15 patients a day, but then they decreased their coverage model to one or two teams on Saturday and Sunday,” Sabharwal explained. “It meant that those who were covering had to each round on 30 patients daily, which made the physicians less efficient and less aggressive in the treatment plan and in the discharge process. Instead of being able to see patients in the morning and again in the afternoon, physicians would have to make care decisions in that one visit.” Sabharwal and his team worked with them to understand the situation and then modified physician coverage to better address patient care.

Department staffing and physician coverage are integral to patient care. And through effective allocation of resources, hospitals may be able to minimize avoidable days, which can reduce the weekend effect, increase efficiency, improve patient satisfaction and decrease costs—all factors that align with the highest quality patient care in today’s value-based environment.

For more information about the weekend effect, click here to read a recent white paper. Be sure to join us on Thursday, May 31 for an educational panel webcast, Bridging the Cost-Quality Divide: Creating the Culture that Empowers Clinicians and Leaders to Deliver High-Quality, Cost-Effective Care. Our expert panelists and moderator will discuss how members can use data effectively to drive better clinical, financial and supply chain outcomes that ultimately lead to a culture of better patient care. For more information or to register, click here.

Published: May 8, 2018