The Weekend Effect: How Saturday, Sunday Hospital Admissions Can Hurt Health Outcomes

One would hope that no matter what day of the week or time of day, precisely the same standard of healthcare would occur. However, data implies that time and day can have a negative effect on health outcomes.

One study published in BMJ Quality & Safety analyzed data from almost 3 million hospital admissions to 28 different teaching hospitals in 4 different countries.  The outcome of the analysis suggested in three of the four nations, that those admitted on the weekend for an emergency had a higher risk of dying within 30 days than those admitted during the week. In the U.S., the risk was 13% higher. The most dramatic difference was in the Netherlands with a 20% greater risk. The study didn't mention causes for the weekend effect.

Researchers indicate that the higher risks might be a result of decreased staffing levels. Study coauthor Paul Aylin of Imperial College London indicates that patients admitted on weekends, particularly stroke sufferers, are not as likely to get a same-day brain scan, less likely to get clot-busting treatment, and have worse outcomes than those accepted during the week.

Often patients or caregivers hear over and over that it was the weekend, that there was only one person here to do whatever for the whole hospital, or that someone was merely cross-covering and did not wish to produce any changes to the plan - the attending would be in next week.

Johns Hopkins University researchers who looked at more than 38,000 head injury patients. likewise documented in a study the weekend effect. They found that the weekend patients were 14% more likely to die from their injuries compared to patients admitted during the week.

Sadly, the clear solution - to increase weekend staffing – is impractical and expensive. Options could include transferring some patients to trauma centers or facilities that have more weekend capabilities.

To learn more regarding the weekend effect and possible solutions, contact us.

Should Medical Marijuana Have a Place in the Hospital?

As of June 2015, 23 states and the District of Columbia have legalized medical cannabis. Should hospitals be following suit?

Many hospitals such as The Cleveland Clinic have stated that they don't recommend using illegal substances to treat health conditions.  However, the top 17 hospitals in the U.S. including the Maya Clinic, Johns Hopkins, and the Duke University Medical center have either taken no public stance on the issue of have evaded making direct statements on the issue.

One argument against medical marijuana in hospitals is the fear of patients falsifying medical documentation in order to smoke marijuana cigarettes or alternative paraphernalia. Some states have handled this problem by restricting legal medicinal marijuana to only the pill or liquid form. New York only permits medical cannabis in pill and oil form and prohibits the sale of the cannabis flower. All other states with legalized marijuana, recreational or medical, currently limit the amounts of live or dried plants a person can have.

Even in states that have legalized medical marijuana, hospitals have been unwilling to allow the administration in their walls. One issue with this is that it can be difficult to abruptly discontinue this treatment upon admittance to a hospital. This is one of the reasons that New York Minnesota, and Massachusetts are allowing use inside their hospitals.

The execution of laws allowing non-smokable types of cannabis is intended to provide aid for those suffering from some cancers, HIV/AIDS, ALS, Parkinson's disease, and more. By implementing the non-smokable forms, hospitals are working to avoid the stigma a 'physician's note' for a headache as a ticket to recreational drugs.

Contact us and let us know how you feel about medical marijuana use in hospitals.

The Complex Physician Credentialing Process

Physician credentialing is the procedure for evaluating practice history and the qualifications of a doctor prior to acceptance of hospital privileges, employment, insurance plan approval, or licensure. There are few agencies that keep credentialing documents, thus, the process is burdensome and time consuming with few shortcuts for doctors who are submitting qualifications to multiple agencies.

Credentialing calls for a formal application by a doctor that is then verified against information from the American Board of Medical Specialties or The National Practitioner Data Bank. Any state where the doctor has an active license is contacted to identify any practice problems. Training and education are checked through direct contact with hospital programs and schools, and registration with the Drug Enforcement Agency and Medicare/Medicaid is usually confirmed. Board certification is also verified. Other essential information includes personal information like credit history or bankruptcy which could reveal a malpractice claim settled out of pocket and unreported to the data bank. Lapses in employment must be explained and are also thoroughly investigated.

Credentialing usually takes about 90 days, however it's best to allow at least 150 days to complete the procedure. Any disparities including missing, outdated, or incomplete information can delay the process. The most common areas that cause delay are verification of current work status, work history, malpractice coverage, hospital privileges, and attestations.

In 1906, the American Medical Association established Physician Masterfile to keep membership information including education, certifications, and training. This information is available to agencies and organizations that verify physician credentials. Background information can be certified by the Federation of State Medical Boards for a fee, paid by the physician.

Many agencies accomplish the credentialing procedure on a physician's behalf for a fee, and these agencies are in high demand because of the need created by the cumbersome credentialing procedure.

Healthcare facilities could be held liable in malpractice suits if they allow incompetent physicians on staff, hence before determining who to hire, as much information as possible is verified.

Have you ever experienced a rise in the credentialing requirements?  Do you have any solutions to this cumbersomeprocess?

Some Good News: Hospitals become Healthier

In 1999, The Institute of Medicine issued a study highlighting the dangers of hospitalization, particularly illness or injury caused by treatment or by medical evaluation. The report called for a comprehensive effort to lessen hospital errors that resulted in death by 50% in five years. Five years later, the goal wasn't satisfied; nonetheless awareness of the situation rallied the healthcare industry to make modifications which are finally showing results.
Measurements of patient safety have been set up to properly gauge the issue. To ensure continuing improvements, we must be able to assess the expenses of patient injury along with the reliability of existing techniques. Patient safety targets must be measured using solid data from the field.
A recent report from the Agency for Healthcare Research and Quality showed that we are improving.  Iatrogenic events (illness caused by medical evaluation or treatment) decreased 17% between 2010 and 2013.  The report revealed considerable declines in pharmacy errors including preventable allergic reactions and dosing with the incorrect medication. Pharmacy errors were reduced by 40% in the 2010-2013 time frame. Another significant section of enhancement was in a decreased likelihood of catheter infections and bedsores. Unfortunately, it remains unclear which important modifications contributed most towards the decrease in iatrogenic harm; though the cost savings are obvious. The savings to Americans were more than 12 million dollars throughout the reporting period. Closer investigation into what factors led to the most improvements in patient safety will hopefully lead to improvements and cost savings for the entire healthcare system.

Contact us today with all your medical legal needs!