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No one chooses the time of an emergency, but two new studies suggest the month and day of the week patients are treated can affect their outcomes.
Image: JoNel Aleccia
By JoNel Aleccia Health writer
updated 7/15/2010 8:17:02 AM ET 2010-07-15T12:17:02

If you’ve made it halfway through July without being hospitalized, and avoided the ICU on a weekend, consider yourself lucky.

Two new studies suggest that there are certain times when it’s dangerous, even deadly, to seek hospital care, validating what doctors, nurses and other health care workers have said privately for years.

“Anecdotally, we’ve always worried about that,” said Michael Cohen, a pharmacist and president of the Institute for Safe Medication Practices, a nonprofit patient safety group. “I have to say, I wouldn’t have surgery on a Friday. Staffing is down and quite honestly you might not get the best treatment.”

In one recent study, researchers from the University of California at San Diego found that fatal medication errors rose 10 percent in July in U.S. counties with teaching hospitals, giving credence to what’s long been known as the “July effect.”

That’s the notion that deaths go up in July, the month that just-graduated medical residents start their new jobs, likely because of mistakes caused by inexperience, said David P. Phillips, the sociology professor who led the analysis.

He examined more than 62 million U.S. death certificates from 1979 to 2006 and found a spike only in July. He also found that the jump was higher in counties with greater concentrations of teaching hospitals.

“The best available explanation was that this increase was associated with changes associated with the new residents,” said Phillips, whose study was published in the Journal of General Internal Medicine.

Operating like the '7-11'
Another study, an analysis of 10 previous studies, found that people admitted to intensive care units on weekends were, on average, about 8 percent more likely to die than people admitted during the week.

“The reason is kind of obvious,” said Dr. Paul E. Marik, a Norfolk, Va., internist who helped conduct the study published in the journal CHEST. “While patients don’t decide when they get sick and they can’t choose the day, hospitals operate as if they were the 7-11.”

Scant off-hours staffing and other administrative problems — including low doctor-to-patient ratios and difficulty obtaining necessary tests and therapies — likely contribute to the increased weekend deaths in the ICU, Marik said.

“Hospitals should operate on the same level during the day as at night,” he said. “People should get the same level of care every day of the week.”

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The new studies are only the most recent reports to suggest that patients are more likely to die during off-hours. A 2008 study of nearly 87,000 cardiac patients published in the Journal of the American Medical Association found that people who had heart attacks in the hospital during nights and weekends were significantly less likely to survive than those who had heart attacks on weekdays.

The issue is familiar to doctors known as hospitalists, who often specialize in staffing around the clock, said Dr. Danielle Scheurer, an assistant professor at Harvard Medical School who works for the Brigham and Women’s Hospitalist Service.

“It’s routinely frustrating,” Scheurer said. “You do expect your patients to get the same care on Tuesday that they do on Sunday and it’s just not the case.”

On weekends, for instance, patients often can’t get certain services, such as peripherally inserted central catheters, or PICC lines, that can speed up treatment. Medications often take longer to get to the bedside during off-hours, she said.

Still, not everyone is convinced that timing is always an issue. Researchers at the University of Tennessee Health Science Center found no evidence of the July effect at their level 1 trauma center, as they reported in a 2009 study in the Journal of the American College of Surgeons.

And Cohen was quick to note that although new doctors don’t get enough training about medication errors in their orientations, it’s not like they’re on their own.

“Medical students and first-year residents are not without supervision,” he said.

Protecting yourself
While no one chooses when to have a heart attack and it might not be possible to avoid hospitals in July, there are ways patients can boost their chances of coming out OK, the experts said.

“It’s a matter of not being afraid to question something you don’t understand,” said Cohen. “Have someone with you who speaks the language of medicine.”

Don’t simply assume that a new doctor is familiar with your case, Scheurer suggested. Instead, patients should double-check that the doctor knows why they’re there and what treatment is planned.  New drugs should also be confirmed.

“When a nurse comes in with a bucket of medications for them to take, ask what’s in the bucket,” she said.

The bottom line, experts said, is that patients shouldn’t be afraid to go to the hospital in July or on a weekend. But they should also watch out for themselves.

“They shouldn’t really avoid or delay care,” Scheurer said. “They should think in a mindset of ‘What would I do on Monday morning?’ — and advocate for themselves in the same way on Sunday.”

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