Emergency patients who are admitted to hospital on Mondays or Tuesdays have shorter waiting times for urgent procedures and shorter hospital stays than those admitted on Fridays or Saturdays, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows.
Researchers analyzed over 126,000 patients admitted through emergency departments in Ontario hospitals between 1988 and 1997 who underwent one of six urgent procedures. They determined how often these procedures were performed on weekends and the wait time until the procedure based upon the day of hospital admission.
Results:
- Only 5% of the urgent procedures were performed on the weekend (defined as Saturday and Sunday). Patients admitted on Fridays and Saturdays had the longest waits for procedures.
- Patients admitted on a Monday or Tuesday had the shortest waits. Those admitted on Sunday had shorter waits than Friday and Saturday.
- Overall, 16% of patients had their procedure performed on the day of hospital admission, 58% had the procedure performed between one and three days of hospital admission, and 25% had the procedure performed between four and seven days.
- Patients with relatively longer waits for procedures had relatively longer total lengths of stay in hospital for all six procedures.
Implications:
“Any sort of wait time for urgent procedures can impair rational decision-making, delay important clinical management, and may affect patient outcomes,” said lead author Dr. Chaim Bell, an ICES adjunct scientist and St. Michael's Hospital inner city health physician and researcher.
“As such, the longer procedural waits for patients admitted to hospital on Fridays and Saturdays shown in our study are a major factor in the inherent process of care differences between weekends and weekdays.
“Moreover, our finding of increased lengths of hospital stay for patients with longer procedure waits represents a real opportunity for cost savings and more efficient care in hospitals if wait times could be reduced.”
Dr. Bell and fellow co-author Dr. Donald Redelmeier point to interventions such as creative scheduling solutions that make the best use of scarce staff resources, and offering weekend procedures to both inpatients and outpatients to maximize efficiency and reduce outpatient queues. But they caution that specific policies “should be left to the discretion of the individual institutions which are most familiar with their priorities.”
The study, “Waiting for urgent procedures on the weekend among emergently hospitalized patients”, is in the August issue of The American Journal of Medicine.
Author affiliations: ICES (Drs. Bell and Redelmeier); Assistant Professor of Medicine (Dr. Bell), and Professor of Medicine (Dr. Redelmeier), University of Toronto; St. Michael’s Hospital (Dr. Bell); Department of Medicine and Clinical Epidemiology Unit of Sunnybrook and Women’s College Health Sciences Centre (Dr. Redelmeier).
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.
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