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Does the timing of your hospital visit affect the quality of care you receive? The answer is yes. But only in certain situations.
A new study from the American Heart Association found that heart attack patients who arrive at the hospital on weeknights, weekends, and holidays have a 13 percent increased risk of dying compared with those arriving during regular business hours. Patients who got to the emergency room during regular workday hours had an average time to treatment of 56 minutes compared with 72 minutes for patients who arrived during those other times. However, both averages are well within the American Heart Association's guidelines of administering angioplasty in 90 minutes or less.
So though the risk was slightly worse on nights and weekends, it was still well within the recommended timeframe that is considered safe. To get more clarity, we talked to Seth Goldstein, MD, a surgical resident at Johns Hopkins University who has a specific research interest in this topic. "If you take emergency situations such as appendicitis or pneumonia or a car accident, there's a growing body of data that suggests getting treated during the week is slightly better than on the weekend," he said. "It's more difficult to assess less serious elective conditions because they aren't usually done at night or on the weekends."
It's worth noting, of course, that you should not wait to go to the hospital if you are in an emergency situation at night or on the weekend. The absolute risk for individual patients still remains low, said Goldstein. But in a large population of patients, the collective risk is something that hospitals are working to reduce. "We study these situations not as a warning to patients, but to raise red flags for hospitals," he said. "We want to make things better and safer. It's never a single individual problem that causes patient care to suffer on these off-hours. It's a systemic issue, a thousand little things that add up."
Is Patient Care Really Worse in July?
Not only could the timing of the day or week affect your visit, but some in the medical community also warn that July is the worst month to visit a hospital. A recent article in U.S. News & World Report suggested that patient care in academic teaching hospitals suffers in July due to the arrival of doctors right out of medical school. "This is not a staffing issue, it's an expertise issue," said Goldstein. "After medical school, all of us have a period of supervised training. The question is: Is there enough supervision such that mistakes are caught?"
The July Effect has been studied extensively, but the actual data as to whether or not it exists is inconclusive, said Goldstein. "In July, in an academic medical center, you may be at slightly higher risk if you're critically ill compared to a community hospital that doesn't have new residents," he explained. But research has proven that, for patients in both kinds of hospitals, treatment outcomes in December are worse than outcomes for patients with the same illnesses treated in July, Goldstein added. So if it's a matter of resident expertise, or lack thereof, in July that is supposedly putting patients at a higher risk, the data does not support it.
There have been a number of changes in the past decade with regard to the supervision of residents who are just out of medical school. "The idea of a July Effect goes way back," said Goldstein. "But starting in 2003, this issue started being addressed directly, and rules were established as to how new doctors were supervised. The evidence is all over the place, but my personal belief is that the July Effect does not exist."
What You Can Do
If you buy into the July Effect, you can always avoid scheduling elective procedures during that month. Obviously, you don't get to pick when emergencies happen, so there's not much you can do in those situations. For less serious health issues, a little bit of common sense will help ensure that you get the best care.
Don't use the emergency room as your primary-care option, especially at night or on the weekend. Doctors' clinics are much better equipped to treat common illnesses such as the cold, the flu, or a mysterious spot on your skin. "True emergencies are a minority of what is seen in an American emergency department," said Goldstein. "Most of the cases are semiurgent issues that have built up over the course of 24 to 48 hours."
If you think something is wrong, he continued, going to the emergency room at 1 p.m. on a Friday is much better than 8 p.m. that same day.
It's these kinds of situations that affect the quality of care on nights and weekends. Everyone is well-intentioned, Goldstein said, but the doctors who know you best aren't there, and familiarity is everything. "You want to go to the folks that know you best," he explained. "If you had your surgery done at hospital A and you start to have pain afterward, don't go to hospital B's emergency room."