MEDICAL MATTERS:Try to avoid falling ill on Saturdays or Sundays, writes MUIRIS HOUSTON
THERE’S PROBABLY not a lot you can do about it, but if you are admitted to hospital as an emergency on either a Saturday or Sunday, you are more likely to die.
According to research published last month in the journal Quality and Safety in Health Care, patients have a 7 per cent higher death rate than if admitted for the same conditions on a Monday to Friday.
The study looked at all emergency patients admitted to some 163 hospital trusts across England between 2005 and 2006. It reviewed four million admissions and 215,000 deaths and covered conditions such as heart attacks, heart failure, stroke and some cancers.
Commenting on the results, study author Dr Paul Aylin, from Imperial College London, said he believed lower weekend staffing levels and fewer senior medical staff in hospitals at weekends were the reasons for the findings.
I reckon the hours worked by junior hospital doctors are also to blame. Notwithstanding the EU working time directive, these doctors still work long weekend shifts. Depending on the specialty, it’s possible to go without sleep for two consecutive nights. On a busy weekend, meal breaks will be at a premium also.
It leaves people dangerously tired. I remember falling asleep at the wheel of my car after working from 8am on a Saturday through to 6pm on the following Monday. Fortunately, no one was hurt in the incident.
Fatigue undoubtedly affects patient care. There is research showing that patients do worse when nurses work shifts longer than 12 hours. Junior doctors working in intensive care make fewer mistakes when they work 16-hour shifts rather than the traditional 36 hours. But by having stricter shifts, you generate more “hand-offs” – the process whereby healthcare staff formally hand over the care of a group of patients to the doctor or nurse beginning the next shift.
Not surprisingly, these transitions pose their own risks. Safety experts argue we should adopt techniques from aviation, such as reading back telephone instructions and adopting standard procedures for formal hand-over meetings.
The need for training time for junior doctors and nurses also impacts on patient safety. “Training is patient safety for the next 30 years,” a UK expert said recently. The review he carried out reported cases where junior doctors were pulled at short notice from training courses and told to cover night shifts, where the opportunity for supervised learning is far less.
However bad the competition for quality training time at present, it is set to get a lot worse since July 1st, when the latest mass changeover of junior doctors took place. Many training posts are vacant; when added to a planned reduction of 1,200 junior doctor posts last week, lots of holes have suddenly appeared in the system.
Senior consultants at Temple Street children’s hospital have warned of an “emergency-only” surgery policy in the hospital due to a 40 per cent shortage in the recommended number of consultant anaesthetist posts at the hospital, a situation exacerbated by difficulties filling non-consultant posts.
July 1st and January 1st have long been recognised as days when it's best not to be a hospital patient. Nurses dread the six-monthly changeover; they are often faced with just the consultant to rely on for continuity of care in the first days of each new cycle. In the UK, the mass changeover takes place on August 1st and February 1st, the chaos of which is well described by Max Pemberton in his book, Trust Me – I'm a Junior Doctor.
“Oh God, it’s dreadful. It’s worse than I could possibly have imagined. I can’t take it any more. I’m so tired and I haven’t even done a week yet
. . . It was evident from the start that the senior house officer and the registrar don’t get on. And even more obvious that the consultants and the registrar don’t get on. Our first meeting was like a bad family party where everyone hates everyone else, but is putting on a united front for the kids.”
So, if you are reading this in hospital, well done for surviving the July 1st changeover. And be nice to the juniors: they will be as sick as you are for the next few weeks.
mhouston@irishtimes.com