Weekend ER patients wait longer for urgent tests

Between the skeleton crews and technician shortages, weekend ills can
leave docs and patients up the creek

By Marjo Johne

A study by the Institute for Clinical Evaluative Sciences (ICES) in Toronto suggests that patients admitted to emergency on a Friday, Saturday or Sunday face longer waits for urgent diagnostic tests and spend more days in hospital than those admitted during the week.

WEEKEND WAITING GAME
Looking at acute care admissions between 1988 and 1997 at 190 emergency departments in Ontario, ICES researchers found that only 5% of urgent tests were done on Saturdays and Sundays. Furthermore, only 30% of patients admitted on a Friday had their diagnostic tests done within 48 hours, compared to 70% for people who came in from Monday to Wednesday. "Most of the procedures — 95% — were done during the week," says Dr Chaim Bell, lead author of the study and a staff physician at St Michael's Hospital in Toronto. "If you expect equal distribution throughout the week, then you should see about 29% of these procedures being done on Saturday and Sunday."

The study, published in the August 3 issue of the American Journal of Medicine, looked at close to 127,000 patients who underwent one of six procedures: magnetic resonance imaging (MRI), coronary angiography, bronchoscopy, electrocardiogram, esophageal gastroduodenoscopy, and ventilation-perfusion or V/Q scanning. Of these six procedures, coronary angiography scored lowest, with only 1.5% performed on Saturdays and Sundays. Esophageal gastroduodenoscopy scored highest at 8%. Patients with longer waits also stayed more days in hospital.

As if all this weren't bad enough, in an earlier study Dr Bell found that patients admitted to hospital on the weekends had a higher mortality rate than those who came in during the week. Luckily there appears to be no link between the longer wait for urgent tests and patient deaths. In fact, with the exception of people who needed a V/Q scan, the ICES study found that patients who had shorter waits for their tests actually had higher mortality rates.

THE ROOT OF ALL DELAYS
So what's behind the weekend lag in testing? It's partly money. Expanding diagnostic testing on weekends requires large capital expenditures for more equipment. But Dr Bell suggests that hospitals can run their equipment at full capacity by opening it up to both outpatients and emergency patients. He feels that the real problem is staffing. "On weekends, hospitals usually go with a skeleton staff," he says.

While the problem sounds straightforward enough, the solution, according to Dr Bell, isn't that simple. To motivate people to work on weekends, he suggests looking at some of the creative approaches adopted by private industry. He cites 3M Canada's weekend program, which pays weekend workers the same wage as their weekday counterparts, even though the latter group works more hours. But Dr Bell acknowledges that there's no quick fix for one of the biggest problems: there just aren't enough skilled technicians in the country. "The biggest problem hospitals are faced with is the lack of trained technologists," he says. "So while the simple answer is to improve staffing, the complex answer is how to do that."

DIAGNOSTIC BONANZA
Joe D'Angelo, manager of diagnostic imaging at the Sault Area Hospital in Sault Ste Marie, agrees. His own department is open seven days a week, 24 hours a day for emergency testing, which means urgent procedures are done within hours of a doctor's request. But this efficiency comes at a price to the hospital's technologists. "There's a lot of stress on these individuals," says Mr D'Angelo, whose staff is on call both evenings and weekends. "They're providing the service during the day and after-hours, so they could be asked to work in the middle of the night and still have to come to work the following morning." In an ideal world, he says, diagnostic test centres would operate at full capacity every day. "But it all goes back to bodies. There just aren't enough professionals available."

Stefan Baranski, spokesperson for the Ontario Hospital Association, says the province's hospitals are well aware of the need to increase testing on the weekend and have responded with a number of measures. In July 2002, a number of hospitals expanded their MRI operating hours to up to 16 hours a day — a 90% increase in some cases. Mr Baranski says hospitals are also making greater use of on-call scheduling for doctors and nurses.

Longterm solutions to the problem aren't in the offing, but of course patient's are still better off waiting longer for treatment than waiting 'til Monday for fear of longer wait times. "If patients are sick, make sure they don't delay going to hospital," says Dr Bell.