Study: Full EMR Adoption can Help Hospitals Overcome “Weekend Effect”

A study by researchers at Loyola University Medical Center has found that full adoption of electronic medical records (EMRs) can help hospitals overcome the “weekend effect.”

The weekend effect refers to patients who undergo surgeries on weekends, leading patients to experience longer hospital stays, and hospitals to face higher mortality rates and readmissions. The study, published in the Annals of Surgery, identified five resources that can help hospitals overcome this effect: increased nurse-to bed ratio; full adoption of EMRs; inpatient physical rehabilitation; a home-health program; and a pain management program.

The researchers examined records of 126,666 patients at 166 Florida hospitals participating in a data base program sponsored by the U.S. Agency for Healthcare Research and Quality. Florida was picked because of its large, diverse population. To determine characteristics of individual hospitals, the patient data were linked to the American Hospital Association Annual Survey database.

Loyola researchers hypothesized that boosting hospital resources before, during and after surgery could overcome the weekend effect. They tested their hypothesis in patients undergoing three types of urgent surgeries that could not be delayed until weekdays: appendectomies, hernia repairs and gall bladder removals.

Researchers examined a five-year period (2007-2011). During these five years, 21 hospitals developed a weekend effect and 41 hospitals experienced a weekend effect for all five years. Twenty-one hospitals developed a weekend effect and 87 hospitals oscillated between having a weekend effect one year and no weekend effect the next.

Researchers were most interested in the 17 hospitals that were able to overcome the weekend effect. They examined 21 hospital resources, and after controlling for patient characteristics, identified five resources that helped to overcome the weekend effect:

• Hospitals that fully adopted electronic medical records were 4.74 times more likely to overcome the weekend effect. Only 12.2 percent of hospitals that had persistent weekend effect had fully adapted electronic medical records, compared with 40 percent of hospitals that overcame the weekend effect.
• Hospitals with increased nurse-to-bed ratios were 1.44 times more likely to overcome the weekend effect. Hospitals that overcame the weekend effect had a median nurse-to-bed ratio of 1.3, compared with a nurse-to-bed ratio of 1.1 among hospitals with a persistent weekend effect.
• Hospitals with home health programs were 2.37 times more likely to overcome the weekend effect. In such programs, skilled caregivers check on patients after they are discharged, providing wound care, administering medications, etc.
• Hospitals with inpatient physical rehabilitation programs were 1.03 times more likely to overcome the weekend effect. Such programs identify patients who require additional physical conditioning prior to discharge or need extra resources at home.
• Hospitals with pain management programs were 1.48 times more likely to overcome the weekend effect. Seventy percent of hospitals that overcame the weekend effect had pain management programs, compared with 49.3 percent of hospitals that had persistent weekend effects.