The "Weekend Effect" And The "July Effect" Suggest That An ER Patient Is More Likely To Die Depending On When They Were Admitted

Does a patient who needs to go to the emergency room be concerned with which day her/his emergency happens to fall on?

The ‘weekend effect’ suggests that data backs up the claim that emergency admittance to the hospital on Saturdays and/or Sundays are more likely to die than those on weekdays, according to a recent article that dives into a published study on this very subject.

The study, published in the British Journal of Surgery, aims to assess the data collected over the last 15 years of emergency room mortality trends between weekend emergency admissions, and weekend emergency general surgery.

"Emergency surgery has long been recognised as an area of surgical practice that is high risk, complex and facing significant challenges with an ageing population.” said Dr. Paul O'Loughlin, senior author of the British Journal of Surgery article.

The original data that first indicated the possibility of a 'weekend effect' was inconclusive, as it grouped all emergency mortality under one roof. For this new study, researchers took a more focused approach to proving the impact of the ‘weekend effect’ by isolating the mortality rates of emergency patients’ day of admission versus the day a patient receives an emergency general surgery, to get a clear view of both sides of emergency mortality.

"In the most recent time period studied we could no longer detect a statistical difference in outcomes on patients operated on at the weekend or during the week. Although significant challenges remain, we are pleased to show the responsiveness of the profession by providing increasingly high quality surgical care to this patient group." said Dr. Paul O'Loughlin, senior author of the British Journal of Surgery article. 

As noted in the Retrospective analysis of 30-day mortality for emergency general surgery admissions evaluating the weekend effect, recently published in the British Journal of Surgery, mortality rates have continued to drop over the years, from 5.4 percent in 2000-2004 to less than 2.9 percent in 2010-2014, a 46 percent reduction. When considering only postoperative mortality, rates fell from 7.5 percent in 2000-2004 to 3.6 percent in 2010-2014, a reduction of 52 percent.

“Overall mortality for emergency general surgery has improved significantly, and in the past 5 years the increased mortality risk of weekend surgery has reduced.” as concluded by study authors.

Ironically enough, the ‘weekend effect’ closely resembles another effect that has left medical community scrambling for answers as to how can mortality rates be improved during the summer, known as the ‘July effect’.

The ‘July effect’, which was chronicled in an article published in Modern Healthcare, is defined by the increase in mortality rates in the summer, coupled with a decrease in hospital efficiency due to of year-end changeovers.

The similarity between both of these effects is death. However, the role played by incoming inexperienced residents in the ‘July effect’ cannot be denied, while the 'weekend effect' is far less conclusive. In The Mystery of the July Effect, study authors hold that this influx of inexperience combined with mass turnover can be dangerous, if not deadly, for patients.

Another glaring difference between the “July effect’ and the ‘Weekend effect’  is that a definite cause has been determined for one. Though a direct link to more deaths in postoperative emergency surgeries during the weekend has not been identified, the increased weekend mortality rates have been.

Both effects, whether ‘July’ or ‘Weekend’, have resulted in heightened attention to mortality risk, systematic training, and ultimately, significantly fewer deaths, by way of either effect.

“The focus on training and safety is heightened in July,” said Dr. Elizabeth Mort, chief quality officer at Massachusetts General Hospital, which is affiliated with Harvard Medical School. “If there is a July effect, it can be mitigated,” she said.

Aptly named, Enclothed Cognition is the official Medelita blog for medical professionals interested in topics relevant to a discerning and inquisitive audience. Medelita was founded by a licensed clinician who felt strongly about the connection between focus, poise and appearance.