How to Improve Outcomes of Weekend Surgeries | News | Loyola Medicine
Monday, April 27, 2015

How hospitals can improve outcomes of weekend surgeries

More nurses, electronic medical records among resources that help overcome "weekend effect"

MAYWOOD, Ill. – Studies have shown that patients who undergo surgeries on weekends tend to experience longer hospital stays and higher mortality rates and readmissions.

For the first time, a new study has identified five resources that can help hospitals overcome this “weekend effect”: Increased nurse-to bed ratio; full adoption of electronic medical records; inpatient physical rehabilitation; a home-health program; and a pain management program.

“Specific hospital resources can overcome the weekend effect seen in urgent general surgery procedures,” senior author Paul Kuo, MD, MS, MBA, first author Anai Kothari, MD, and colleagues reported. The study was released April 25, 2015, in a podium presentation at the American Surgical Association meeting in San Diego.

Several reasons have been proposed to explain the weekend effect, including reduced staffing and resources and fewer experienced doctors and nurses working on weekends.

Loyola researchers hypothesized that boosting hospital resources before, during and after surgery could overcome the weekend effect. They tested their hypothesis in patients undergoing three types of urgent surgeries that could not be delayed until weekdays: appendectomies, hernia repairs and gall bladder removals.

The researchers examined records of 126,666 patients at 117 Florida hospitals participating in a data base program sponsored by the U.S. Agency for Healthcare Research and Quality. Florida was picked because of its large, diverse population. To determine characteristics of individual hospitals, the patient data were linked to the American Hospital Association Annual Survey database.

Of the 21 hospital resources researchers examined, five were found to help overcome the weekend effect after controlling for patient characteristics:

  • Hospitals with increased nurse-to-bed ratios were 1.44 times more likely to overcome the weekend effect. Seventeen hospitals that overcame the weekend effect had a median nurse-to-bed ratio of 1.3, compared with a nurse-to-bed ratio of 1.1 among 41 hospitals with a persistent weekend effect.
  • Hospitals with home health programs were 2.37 times more likely to overcome the weekend effect. In such programs, skilled caregivers check on patients after they are discharged, providing wound care, administering medications, etc.
  • Hospitals that fully adopted electronic medical records were 4.74 times more likely to overcome the weekend effect.
  • Hospitals with inpatient physical rehabilitation programs were 1.03 times more likely to overcome the weekend effect. Such programs identify patients who require additional physical conditioning prior to discharge or need extra resources at home.
  • Hospitals with pain management programs were 1.48 times more likely to overcome the weekend effect.  

Researchers plan to conduct a follow-up study of hospitals in California, which also has a large, diverse population.

The study was conducted by Loyola’s predictive analytics program, which mines large data sets to predict health outcomes. In addition to the weekend effect study, researchers are studying, for example, how many rectal cancer operations a hospital needs to perform for the best results, and whether having a trauma department confers a beneficial “halo effect” on patient outcomes across the board.

Large new databases, electronic medical records and more powerful computers are enabling researchers to conduct such studies. “We’re now able to ask and answer a broad range of questions that could significantly help improve patient care and reduce costs,” Dr. Kuo said. Dr. Kuo heads Loyola’s analytics group, One to Map Analytics. (One-to-map is a common computer command in analytics research.)

Dr. Kuo is the John P. Igini professor and chair of the Department of Surgery of Loyola University Chicago Stritch School of Medicine.

The study is titled, “Components Of Hospital Perioperative Infrastructure Can Overcome The Weekend Effect In Urgent General Surgery Procedures.” In addition to Dr. Kuo and Dr. Kothari, other co-authors are Matthew Zapf; Robert Blackwell, MD; Victor Chang; Zhiyong Mi, PhD; and Gopal Gupta, MD.

The complete manuscript of this study and its presentation at the American Surgical Association's 135th Annual Meeting, April 2015, in San Diego, California, is anticipated to be published in the Annals of Surgery pending editorial review."

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.