The “Weekend Effect” and Medical Malpractice in Canada

Recent media reports have revisited the so-called “weekend effect”: the increased rate of death among patients admitted to hospital on a weekend, as compared to patients admitted on a weekday.

While health experts have been aware of this phenomenon for years, the anomaly has continued, without one clear and cogent reason why. How widespread is this variance in Canada and what does this mean for patients and families?

Examining the Weekend Effect in Canada

The weekend effect was most recently studied in Canada by the the Canadian Institute for Health Information (CIHI) in 2014.

The CIHI study examined hospital discharge data collected for a three-year period (2010-2013) for 9 million patient admissions to Canadian hospitals between 2010 and 2013. Weekend admissions were defined as admissions occurring between 12 midnight on Saturday and 11:59 p.m. on Sunday (and included statutory holidays).

The study concluded that patients admitted for urgent (unexpected) problems on a weekend had 4% higher odds of dying as compared to patients admitted during the week. Among these urgent patients, those who went underwent surgery had 7% higher odds of dying, whereas non-surgical patients had 3% increased odds of dying. Overall, the study found that if patients admitted on weekends had the same mortality rates as those admitted on weekdays, there would be 400 fewer in-hospital deaths among urgent patients.

Patents who were not affected by the weekend effect:

• Children;
• Patients admitted for obstetrical or mental health care;
• Patients admitted for elective surgery or other planned care.

Hypotheses About the Weekend Effect

The CIHI study noted that there are two possible reasons for increased mortality on the weekend:

• Patients admitted on the weekend may be sicker than patients admitted during the week; or
• Hospital services on the weekend may be less available or of poorer quality than services provided during the week.

Weekend Behaviour

The study noted that changes in human behaviour on weekends might influence the use of health care services.

Individuals with less-severe conditions may not come to the hospital on the weekend as readily as they would during the week for various reasons:

• Mildly ill patients may postpone care until after the weekend or until their symptoms become more severe;
• Lower stress levels on weekends might reduce symptoms of illness or temporarily dispel physical symptoms whereas weekday activities and stress may prompt people to seek medical care for the same symptoms.

Weekend Staffing

The CIHI study also highlighted the information that had been provided by a large urban community hospital with respect to weekend admittance. The information revealed that:

• Physician coverage is reduced on weekends (one or two physicians cover all non-surgical inpatients, compared with four to six physicians on a weekday);
• Allied health support (i.e. other health professionals including pharmacists, respiratory therapists, etc.) is decreased on unavailable on a weekend;
• Nursing coverage throughout the hospital is at the same level on a weekend as it is on weekdays, but on a weekend, nurses may not have access to all nursing clinical supports (such as clinical practice leaders, nurse practitioners, etc.);
• Access to some diagnostic or therapeutic interventions is less readily available on weekends.

This information is instructive and provides some idea of why the weekend effect occurs, however, the study noted that it is difficult to pinpoint the potential reasons for the weekend effect.

The Weekend Effect and Specific Diseases/Conditions

The study concluded that the four groups with the highest number of excess deaths were:

• Heart attack patients;
• Chronic kidney disease patients;
• Lung cancer patients; and
• Digestive malignancy (i.e. colon cancer) patients.

Some Conclusions

The study noted that it is challenging to point to definitive reasons for the weekend effect and concluded that further investigation of all potential explanations would need to be tested with additional information on hospital staffing, wait times, and patient severity.

Experts have stressed that the data collected should be kept in perspective, and that the weekend effect in Canada is “very small”, but note that Canadian hospitals should ensure that staffing on weekends is sufficient to meet best practice guidelines for the high-risk conditions seen in acute care.

The Weekend Effect and Medical Malpractice

Realities such as reduced physician coverage, decreased allied health support, decreased nursing clinical supports and less access to diagnostic or therapeutic interventions can result in a number of harmful issues including hospital error, medical misdiagnosis, delayed diagnosis, incorrect treatment, delayed treatment, incorrect medication prescribed, or no treatment undertaken at all. All of this can lead to death or catastrophic injury with lifelong implications.

If you lost a child or other loved one due to physician or hospital error, misdiagnosis, a delayed diagnosis, missed diagnosis, or a failure of a medical professional to diagnose, or if you suspect that the actions of a medical professional have caused a devastating impact on your life, or the life of your loved one, consult with a trusted legal professional as soon as possible.

At Sommers Roth & Elmaleh, our knowledgeable Toronto medical malpractice lawyers regularly keep track of ongoing matters in health care. We are committed to providing excellent legal representation to patients who have been affected by inadequate or unprofessional medical care. We are one of the oldest medical malpractice firms in Toronto and offer compassionate and knowledgeable guidance on every aspect of a medical malpractice claim. Over the years, we have helped clients from across Canada, including throughout Ontario, and in Alberta, British Columbia, Saskatchewan, and the Maritimes. Call us at 1-844-777-7372 or contact us online for a free consultation.