Death on the weekend?! - Austrian study notes increased mortality risk for patients admitted to ICUs at weekends

Mon, 2017 / 11 / 13

The "weekend effect" was confirmed once again. Possible differences in mortality risk for patients admitted to intensive care units (ICU) either on a weekday or on weekends were studied by emergency physician Dr. Paul Zajic of the Medical University of Graz and his team. The analysis includes data from about 150,000 patients who were treated between 2012 and 2015 at one of 119 Austrian intensive care units. About 17% of these patients (about 26,000 men and women) were admitted to intensive care at the weekend; about 14,000 died during their stay. Despite strong patient heterogeneity and case mix variations (high variance in disease severity and the reason for admission to the ICU between weekdays and weekends), the scientists are reporting a significantly higher mortality risk for patients entering the ICU or undergoing scheduled operations at weekends: Patients admitted to ICUs on a Saturday had a death risk which was 11% higher, even 15% on a Sunday, than those admitted on a weekday. At the same time, it has been observed that the quality of intensive care on admission day is significantly worse at weekends in comparison to weekday care; especially, with regard to key treatments such as the placement of central venous catheters, peripheral arterial lines, or lung function-improving treatments.

Even though Zajic and his team emphasize that their study results are not necessarily transferable to other countries or health care systems and that the reasons for the "weekend effect" cannot be conclusively answered, the publication of the study in Critical Care has made headlines in Germany.

The emergency physician Prof. André Gries, head of the central emergency room at the Leipzig University Hospital, states similar problems induced by ubiquitous staff shortage and restricted access to specialists at weekends in small German clinics as described in the Austrian study.

The National Association of Statutory Health Insurances Funds (GKV-SV) also took the study results as an opportunity to initiate and foster a reform of emergency care. "We need a restructuring of emergency care in Germany and we need it fast," said Florian Lanz, spokesman of the GKV-SV. The needs for action formulated in a position paper at the end of August 2017 particularly address the lack of coordination between the emergency medical services of the Association of Statutory Health Insurance Physicians, the rescue services and the emergency departments of hospitals. Suggestions for improvement such as the introduction of a stationary emergency stage concept, the establishment of central emergency rooms or the revision of hospital ambulance financing are proposed.

The reasons for the "weekend effect" proven in the Austrian health system and often described in the German health context have not been clarified scientifically. However, health experts agree that an insufficient allocation of staff associated with increased workload, inexperienced workers, and delayed accessibility to specialists are key criteria for mortality risk in intensive care units.

The many years of experience of the SKC Beratungsgesellschaft mbH in the area of leadership and teaming in the hospital context shows that some of these problems can be compensated or at least reduced by "well-balanced teamwork". Multidisciplinary teams that communicate regularly, directly, and trustfully with each other and feel psychologically secure are much more capable of meeting the described challenges efficiently and with a high-quality outcome.

For more information, please note the following links:

Zajic et al. (2017): Weekends affect mortality risk and chance of discharge in critically ill patients: a retrospective study in the Austrian registry for intensive care. CritCare 2017 (download at: https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1812-0)

https://www.biomedcentral.com/about/press-centre/science-press-releases/07-09-17

https://www.aerztezeitung.de/medizin/fachbereiche/ains/article/942693/intensivstation-einlieferung-wochenende-erhoeht-sterberisiko.html

http://www.tagesspiegel.de/weltspiegel/intensivstation-einlieferung-am-wochenende-erhoeht-sterberisiko/20301170.html

https://www.gkv-spitzenverband.de/media/dokumente/presse/publikationen/Positionspapier_Notfallversorgung_barrierefrei.pdf