For 20 years, the evidence has piled up in study after study: Patients admitted to hospital on the weekend are more likely to die or have poor outcomes, as reduced staff levels cause delays in tests and treatment.
Yet the health-care system has done little or nothing to address the problem, say two Canadian doctors who have just published a call to action for hospitals to curb the so-called "weekend effect."
The problem is complex and the solutions would be no less so, but it is time for health care to "restructure the hospital work week" and make Saturday and Sunday just as safe for patients as any week day, they said.
Other doctors who have studied the problem echoed their appeal, suggesting that even relatively minor, inexpensive changes could save lives.
"It really is a pervasive thing that has happened in multiple aspects of medicine," said Dr. Chaim Bell, co-author of the new article in the journal BMJ Quality and Safety. "The problem has been trying to get a call to action. It's hard to change an ingrained approach to care and organizational structure."
One prominent patient advocate suggested Tuesday that achieving an overhaul of scheduling that resulted in more shifts on Saturday and Sunday might, in fact, be all but impossible.
"Health care is delivered primarily by middle-class people," said Sholom Glouberman, spokesman for the group Patients Canada. "Doctors tend to be upper middle-class people, and they tend to arrange their lives so they don't work on the weekend."
A representative for many of the country's hospitals, meanwhile, said he welcomed Dr. Bell's editorial, while calling for more study.
"This research is important," said Anthony Dale, interim CEO of the Ontario Hospital Association. "A first step will be to fully understand the facts behind the findings, such as prevalence and contributing factors, so that they can be properly examined and addressed."
In the meantime, patients should not fear going to hospital on the weekend, but ask caregivers if any delay in testing or therapy is safe, experts say.
Dr. Bell, an internal-medicine specialist at Toronto's Mount Sinai Hospital, along with colleague Dr. Donald Redelmeier of the city's Sunnybrook Health Sciences Centre, have been among the pioneers of research in the area. Their 2001 review of Ontario hospital data found patients admitted on the weekend were significantly more likely to die of 23 common, potentially fatal conditions, and no less likely to die from other ailments.
The medical literature over the past several years has been replete with similar papers, bearing titles like "Don't get sick on the weekend" and "Weekends: a dangerous time for having a stroke?"
A U.S. study published this year found a relatively modest 3% increase in mortality for patients admitted to hospital on the weekend. But that would translate into "thousands and thousands" of potentially preventable deaths, said Dr. Adam Sharp, a University of Michigan emergency-medicine doctor and co-author of the research.
"The day of the week should not predict whether you die or not, no matter how small the difference," he said.
A 2007 Canadian study suggested that stroke patients who landed in hospital over the weekend were 14% more likely to end up dead.
"If you look at how many cars are in the parking lot on weekends, versus the weekdays, you will realize the basic difference," said Dr. Gustavo Saposnik, a neurologist at Toronto's St. Michael's Hospital and the lead author. "And that is obviously translated into the care, the number of providers available to provide excellent care."
Researchers stress that they can only speculate about the reasons for the weekend effect. As well as fewer staff and the resulting delays, it could also be a function of less-experienced, more junior nurses and doctors being on duty, they say.
And the solutions are not as simple as they might appear. A wholesale scheduling change that allowed hospitals to function at the same level on the weekend as during the week would likely be prohibitively expensive and unnecessary, said Dr. Sharp.
It will be important to focus on specific areas where weekend care is proven to lead to poor patient outcomes, and address them directly, Dr. Bell said.
In the care of stroke patients, that does not necessarily mean having more people on duty, said Dr. Saposnik. Much could be done by ensuring weekend staff are trained to perform key tasks, he said. Those include swallowing assessments designed to ensure patients do not aspirate food into their lungs — a potential source of infection — and simply getting stroke sufferers to walk around, staving off potentially dangerous blood clots in their legs.
Mr. Glouberman suggested, however, that energy should be focused, not on beefing up hospital services on the weekend, but improving community-based care for people with multiple illnesses, partly by training more multi-skilled geriatricians.
That way, such patients would be less likely to have to be admitted to the hospital — on any day of the week, he said.