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Nearly a year after "starting out" on the inpatient wards as a new hospitalist, there has been one idiosyncrasy that I just can’t seem to understand: Hospitals and skilled nursing facilities decrease their staffing and services on the weekends. Though I was aware of this as a resident, because it was frustrating, now, as an attending, it’s nearly surreal. I am the one responsible for the length of stay, patient satisfaction scores, and health care cost savings, and it just doesn’t make sense to decrease available services because of the weekend. How can it be good for patient care?
While Saturdays and Sundays can be slower from an admitting standpoint, because there is no clinic activity to generate a percentage of admissions, Friday night is often one of the busiest admitting nights of the week; and those patients admitted then, along with everyone else who failed to discharge during the week, have to be cared for on the weekend. If there are sick patients, there should be services for those patients. This means that PICC teams, wound care, PT/OT, nutrition, MRI staff, consultant services, case managers, and even hospitalists should treat Saturday and Sunday like any other day, and that staffing should reflect that. How can I as a hospitalist meet the goals of the system and take care of the patient if I don’t have the resources?
What usually happens is that providers "cover" for each other, which in my opinion, leads to more stressed-out staff, decreased time spent with patients, and decreased quality of care. I bet patients can sense it. Consultants who are spread thin are more likely to bark at each other, and things are triaged to what can "wait until Monday." For the inpatient, should anything wait until Monday?
I think nothing is as compromised, from a hospitalist standpoint, as case management and discharge capabilities. On the hospital and skilled nursing facility sides, the stress and complexity of discharge situation drastically increases on the weekends, yet case management is reduced by more than half. Is it fair or even safe for patients to stay another expensive night in the hospital simply because it is a weekend or a holiday? As Fridays approach, I find myself planning discharges around the looming weekend. Sometimes, I am faced with choosing to either rush things to prepare for the Friday discharge or accepting that discharge will simply have to wait until Monday.
I suppose there are many reasons the system is the way it is, but the biggest factor, as always, is likely money.
Days off have to come from somewhere and if another provider is not going to "cover," the only other option is to hire more case managers, more hospitalists, more fellows, and more ancillary staff for PICC lines, physical therapy, MRIs, wound consults, and transition of care.
In the end, if our goals truly are to increase patient satisfaction, decrease complications, decrease length of stay, and decrease patient frustration, then we should start thinking of our inpatient health care system like we would the fire department or even Walmart: open and fully staffed 365 days a year. Because illness, like fire and capitalism, doesn’t take the weekend off.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
Nearly a year after "starting out" on the inpatient wards as a new hospitalist, there has been one idiosyncrasy that I just can’t seem to understand: Hospitals and skilled nursing facilities decrease their staffing and services on the weekends. Though I was aware of this as a resident, because it was frustrating, now, as an attending, it’s nearly surreal. I am the one responsible for the length of stay, patient satisfaction scores, and health care cost savings, and it just doesn’t make sense to decrease available services because of the weekend. How can it be good for patient care?
While Saturdays and Sundays can be slower from an admitting standpoint, because there is no clinic activity to generate a percentage of admissions, Friday night is often one of the busiest admitting nights of the week; and those patients admitted then, along with everyone else who failed to discharge during the week, have to be cared for on the weekend. If there are sick patients, there should be services for those patients. This means that PICC teams, wound care, PT/OT, nutrition, MRI staff, consultant services, case managers, and even hospitalists should treat Saturday and Sunday like any other day, and that staffing should reflect that. How can I as a hospitalist meet the goals of the system and take care of the patient if I don’t have the resources?
What usually happens is that providers "cover" for each other, which in my opinion, leads to more stressed-out staff, decreased time spent with patients, and decreased quality of care. I bet patients can sense it. Consultants who are spread thin are more likely to bark at each other, and things are triaged to what can "wait until Monday." For the inpatient, should anything wait until Monday?
I think nothing is as compromised, from a hospitalist standpoint, as case management and discharge capabilities. On the hospital and skilled nursing facility sides, the stress and complexity of discharge situation drastically increases on the weekends, yet case management is reduced by more than half. Is it fair or even safe for patients to stay another expensive night in the hospital simply because it is a weekend or a holiday? As Fridays approach, I find myself planning discharges around the looming weekend. Sometimes, I am faced with choosing to either rush things to prepare for the Friday discharge or accepting that discharge will simply have to wait until Monday.
I suppose there are many reasons the system is the way it is, but the biggest factor, as always, is likely money.
Days off have to come from somewhere and if another provider is not going to "cover," the only other option is to hire more case managers, more hospitalists, more fellows, and more ancillary staff for PICC lines, physical therapy, MRIs, wound consults, and transition of care.
In the end, if our goals truly are to increase patient satisfaction, decrease complications, decrease length of stay, and decrease patient frustration, then we should start thinking of our inpatient health care system like we would the fire department or even Walmart: open and fully staffed 365 days a year. Because illness, like fire and capitalism, doesn’t take the weekend off.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
Nearly a year after "starting out" on the inpatient wards as a new hospitalist, there has been one idiosyncrasy that I just can’t seem to understand: Hospitals and skilled nursing facilities decrease their staffing and services on the weekends. Though I was aware of this as a resident, because it was frustrating, now, as an attending, it’s nearly surreal. I am the one responsible for the length of stay, patient satisfaction scores, and health care cost savings, and it just doesn’t make sense to decrease available services because of the weekend. How can it be good for patient care?
While Saturdays and Sundays can be slower from an admitting standpoint, because there is no clinic activity to generate a percentage of admissions, Friday night is often one of the busiest admitting nights of the week; and those patients admitted then, along with everyone else who failed to discharge during the week, have to be cared for on the weekend. If there are sick patients, there should be services for those patients. This means that PICC teams, wound care, PT/OT, nutrition, MRI staff, consultant services, case managers, and even hospitalists should treat Saturday and Sunday like any other day, and that staffing should reflect that. How can I as a hospitalist meet the goals of the system and take care of the patient if I don’t have the resources?
What usually happens is that providers "cover" for each other, which in my opinion, leads to more stressed-out staff, decreased time spent with patients, and decreased quality of care. I bet patients can sense it. Consultants who are spread thin are more likely to bark at each other, and things are triaged to what can "wait until Monday." For the inpatient, should anything wait until Monday?
I think nothing is as compromised, from a hospitalist standpoint, as case management and discharge capabilities. On the hospital and skilled nursing facility sides, the stress and complexity of discharge situation drastically increases on the weekends, yet case management is reduced by more than half. Is it fair or even safe for patients to stay another expensive night in the hospital simply because it is a weekend or a holiday? As Fridays approach, I find myself planning discharges around the looming weekend. Sometimes, I am faced with choosing to either rush things to prepare for the Friday discharge or accepting that discharge will simply have to wait until Monday.
I suppose there are many reasons the system is the way it is, but the biggest factor, as always, is likely money.
Days off have to come from somewhere and if another provider is not going to "cover," the only other option is to hire more case managers, more hospitalists, more fellows, and more ancillary staff for PICC lines, physical therapy, MRIs, wound consults, and transition of care.
In the end, if our goals truly are to increase patient satisfaction, decrease complications, decrease length of stay, and decrease patient frustration, then we should start thinking of our inpatient health care system like we would the fire department or even Walmart: open and fully staffed 365 days a year. Because illness, like fire and capitalism, doesn’t take the weekend off.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
