Brenda's hospital stay was moving along quite nicely, and she was relieved to have recieved the lifesaving help with her medical problems that almost killed her 4 nights ago. She was recovering from a procedure that had just taken place on a Wednesday. She was looking forward to going home this week. But by Thursday she began to develop a little shortness of breath. The doctor gave her some medicine to pull fluid from her lungs. The problem resolved easy enough, but the doctor decided to move her into the ICU for a "short time" just to watch her closely given her complicated medical history. He said the problem was that the IV fluids were running too fast and she became fluid overloaded. He told her that he expected she would go home in a couple of days. She spent all day Friday in an ICU bed where she was kept awake by nurses coming in and checking on her every 2 hours and all kinds of beeps, whistles, and alarms.

Her doctor came in the next day to check up on her, but it wasn't her regular doctor. He says he is covering for his partner. He goes on to say that he doesn't feel like she is ready to go home yet and orders an echocardiogram. He orders this test to check out her heart because of the shortness of breath episode the previous week. There is a major problem though. The echocardiogram department doesn't come in on the weekends. She ends up having to wait in ICU all weekend until Monday when her regular doctor comes in and discharges her home cancelling the echo since she had one done already a month ago. What just happened? She was told on Thursday that she could leave in a couple of days. Now, four days later, she is finally leaving. Everything just seemed to stop on the weekend.

 This is a common problem in most hospitals around the country.  Care seems to slow down or stop on the weekend.  It is usually worse in the smaller hospitals than in the big ones.  But it usually hapens to some extent in all hospitals.  There are multiple reasons for this that I will cover in this article.

In all hospitals that I have advocated in, when the weekend comes there is a massive changeover of the physicians. Most doctors practice in groups. One doctor will work one or two hospitals primarily during the week. Then, when the weekend comes, one of the doctors in the group (not usually the one who goes to that hospital) will take call and go see the patients. The result is that you get a physician who doesn't know you, doesn't know your history, has to catch up on the course of your hospital visit, and decide on the next course of action for you all in a few minutes because they have a huge list of other patients to see. Many times this means that the covering doctor will simply put out fires until the original doctor returns on Monday.

Sometimes a covering physician may be on the fence about whether you can go home or not. They will usually err on the side of not sending you home. They don't want to take the chance of stepping on their partner's toes and sending you home when your physician may not want you to go home. So why don't the physicians talk to one another then? This is another common question I am asked. The answer is that they do communicate to one another. Some groups do it better than others. Some groups actually give report at call change with one another. Usually the sicker patients get the most detailed reports given about them. Still, not everything is covered and things get missed.

Another way physicians communicate is through writing progress notes in the chart. The bad part is that many times what is said in the patient room to the patient isn't always written in on the chart. If it isn't written on the chart, then as far as the covering physician is concerned it wasn't said at all.

The key to avoiding these problems is communication. You can actually improve communication by writing down those things that the physician says and reminding him/her to write it in the chart so that the covering physicina can know it that weekend. A health advocate or a knowledgeable family member in the right healthcare field can help with this. Usually medical personnel take other medical personnel more credibly and seriously when they talk.

Small hospitals face many problems of their own. Sometimes these hospitals are so small that they can only staff a few services on the weekend. In the example above the patient was unable to get an echocardiogram on the weekend. This was because the hospital didn't staff echo techs on the weekend to run the machines. These types of problems are not uncommon in small hospitals around the country.

The answer to these problems lies within administration. It is important to understand that it is administration and not the doctors and nurses that run the hospital. Conversely, it is also important to understand that it is your nurses who should be providing your voice to administration to fix these problems as they arise. If your nurse refuses to call administration and speak on your behalf, you may need to call them yourself if you are able or to have a family member knowledgeabel about healthcare or a health advocate call for you. Knowledge of the problem by administration is usually the only thing that can fix the issue in that moment as well as fix the system for the future.

The answer is usually as simple as administration calling someone in to do the test, then changing the scheduling around so that at least someone is on call to come in and do the tests on the weekend. The important thing is to make sure administration is aware of the problem so it can be fixed.

On the weekend most hospital administration is off work. They usually work the regular Monday-Friday schedule. When issues come up, the hospital staff tries to put fires out until Monday when administration comes in to make executive decisions. Even though this is the way it is usually handled, doesn't meain it is the right way to handle things. The truth is, that hospital administration is responsible for the running of the hospital 24/7. There should be at least one administrator on call for the weekend. If you need them, get in touch with them. The nurse should be able to reach them. If the nurse claims to not know how to reach them, then ask to speak to the house supervisor. He/she can get you in touch with the administrator. It is important to note that this can sometimes cause quite a fuss with the staff when you do this. This should be used as a last resort when nothing else can be done. See The Role Of The Nurse for more information on dealing with weak staff and the steps that you can take to get things moving.

 Another thing that happens on the weekend at hospitals is that the nursing staff almost totally changes.  Nurses who have been taking care of you all week long suddenly disappear and a staff of strangers appears to take care of you.  They don't know you as personally or as well as the nurses who have been taking care of you all week .  They learn more about you as the weekend progresses, but you start off as relative strangers.  In fact, the staff changeover is so great on the weekend that they actually have a different classification of nurses called weekenders. 

When a covering physician is having to decide whether to discharge you or not, the weekend nurse often doesn't know your story intimately enough to say, "Dr. S. said that she could probably go home today if she continued to do well." This often times holds up some discharges over the weekend.

The hospital is a complex environment to try to navigate alone. I hope that these articles help you to get the most positive and successful experience you can out of your healthcare. A strong family member who has the right healthcare background and plenty of time to help you is a great asset in this environment. If one isn't available, a health advocate is a very valuable source of help since it is what they do for a living. Good Luck and Stay Well.