Don’t get ill at weekends

I’m sorry it’s been a while since my last post but I’ve been rather busy with our new baby boy, Amos. One thing that became apparent during the birth was that hospitals really aren’t geared up to work evenings or weekends.

A friend and co-author, Professor Simon Jones, has recently done some work on this with Dr Foster, the publishers of the annual hospital guide. Their research found that patients who are admitted at the weekend are more likely to die than those admitted during the week. They suggest the causes of this variation in death rates include staffing (fewer senior doctors are available at weekends) and problems accessing hospital services such as diagnostics.

This chimes with some other research we did looking at the rates of cancelled procedures. Among other factors, elective procedures are more likely to be cancelled on Mondays. Our working hypothesis is that this is because patients admitted over the weekend are still occupying beds on Monday because there aren’t enough senior doctors around to properly treat and discharge patients, or that patients can’t access the necessary services to be diagnosed or treated over the weekend.

This also echoes my own recent experience. Amos was born at 2:30am but because he had a fast heart rate (tachycardia) and a slightly elevated temperature the doctors were concerned that he may have an infection. Their solution was to begin treatment with IV antibiotics and to send a blood culture to the lab to test. If nothing has grown after 48-hours they stop the treatment and send you home, but if something is found they complete the course of antibiotics and, where necessary, switch to a more specific antibiotic.

The problem was that the lab is closed over the weekend. Therefore the earliest the sample could be plated was Monday morning, but obviously there’s a backlog of samples sent over the weekend. A 48-hour wait therefore becomes a 4-day plus wait depending upon the backlog.

Why does this matter? Well patients can only be discharged from the post-natal ward after a negative test result, and a patient occupying a bed potentially prevents a patient from being brought down from a delivery room, which in turn prevents a patient being admitted to that delivery room. This can quickly escalate to a situation where the labour ward needs to be temporarily closed and patients turned away.

Borrowing from the theory of constraints, the laboratory is a bottleneck in the supply chain of healthcare, and a chain is only as strong as its weakest link. Throughput, the number of patients treated or the number of deliveries performed, could be increased by tackling this constraint.

Oftentimes, constraints cannot be removed and the production system must be redesigned around it. However, in this case it seems fairly easy to fix. Keep the laboratory open 24-7, 365 days just like the wards but with fewer evening, overnight and weekend staff to match the demand for laboratory tests.

In our case, the wait was even longer as the porter allegedly “misplaced” our sample. Thankfully, the result was negative but in the meantime we were all worried and Mrs C was kept prisoner in the hospital.

It’s all rather worrying. People get ill 24-7, 365 days a year and accident and emergency departments are used to that. Perhaps the rest of the health service needs to adapt to this as well.  For the moment the message is – don’t get ill at weekends.



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