Don’t have a GI bleed on the weekend, and why you’re more likely to die on Saturday and Sunday

Patients don’t choose the days they get sick.

There are several studies, specifically dealing with heart attacks, showing that the mortality rate increases when a patient visits the hospital during the weekend.

It appears that the same goes for upper GI bleeding. MedPage Today discusses a recent study showing that “patients with nonvariceal upper gastrointestinal hemorrhage had a 22% increased mortality risk on weekends, and those with peptic ulcer-related hemorrhage had an 8% higher risk.”

Staffing issues, leading to delayed endoscopies, appear to be chief culprit. Minutes count in cases of GI bleeding, so the delay is a likely explanation for the higher mortality rates.

Especially in community hospitals, doctors often cover for one another, and in general, there are less physicians available. Short of having more doctors on call, a prospect that faces long odds as hospitals are loathe to pay specialists for additional call, I’m not sure what can be done to rectify this statistic.

One suggestion is to have so-called “bleed teams,” where staff can be quickly mobilized to respond solely to acute GI bleeds. But again, this likely would require more staff, and it’s dubious that hospitals are willing to bear the additional cost.

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  • jb

    What can be done to “rectify this statistic” is to restore some market economics to medicine. Real tort reform will help also.. Years ago, there were actual CPT codes that were used to compensate docs for after hours work. If a doc came from his office or home for an urgent situation, there was a code for that. After hours, a different code. After midnight, another code. Use of these codes went a long way to compensate the doc for the inconvenience of interrupting whatever he was doing to tend to the patients with urgent needs.

    Today, an upper endoscopy done in the hospital pays ~$130, add $100 if a bleeding source is found and controlled. There will be another $100 or so for a consultation. No increase in compensation to account for the interruption of other activity, increased risk, and inconvenience.
    The only way to earn a reasonable wage doing endoscopy is to be able to do a dozen or so in a morning. It’s just not reasonable to expect a GI specialist to spend a couple of hours in the middle of the night or on a weekend trying to stop a bleed under terrible conditions- in the ICU, poor lighting, support staff not optimal, all for a couple of hundred dollars. The patients are sick and frequently unstable, outcomes are poorer, and lawsuits are more common.
    Most GI docs earn a comfortable living doing elective procedures, many in their own profitable endoscopy suites. They have very little motivation to get involved in Saturday night urgencies at high risk and minimal reimbursement.
    Tort reform and free markets will save lives.

  • Anonymous

    “They have very little motivation to get involved in Saturday night urgencies at high risk and minimal reimbursement.”

    Ultimately, it is not cost effective to do emergency GI procedures on the weekend. Perhaps we should just cut our losses and quit pretending that someone’s life is really worth more than money.

  • Anonymous

    But I thought that the physicians today were the ones who worked long, hard hours during residency and aren’t going to punch the clock?

    Oh wait, that’s just a line that they feed the residents when they’re trying to milk them for all the time they can possibly get. The attendings aren’t going to come in on the weekend. Bunch of crap.

  • Anonymous

    Anon 12:45

    With respect allow me to correct your terminology:

    It is very cost-effective . . . the cost for saving a life is very very reasonable. The cost is far less than the value.

    What it is not is financially worthwhile while for the doctor. The cost, which is a tiny % of the value, is deemed already too high to the third parties who pay for them to agree to a slight increase in that cost to make it pay for the doctor.

    The real problem is that the “third party” who makes that choice aren’t the ones getting the value.

  • Anonymous

    We should just stop paying as much for procedures and pay cognitive specialties to cure the GI bleed with their pen. Everybody hates a specialist until they need one to bail them out.

  • Anonymous

    “Patients don’t choose the days they get sick.” It sure seems like it somedays. Our ER gets flooded on Monday and Friday, then runs light on the weekends. We have a huge spike starting ~1700 when parents get off work (and the PCPs office closes), and on Sundays either after church or after a Cowboy game (during the game feels like protected time). I understand the morning ~0700-0800 jolt, but the others are kind of annoying.

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