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Change to Seven Day System, Urges Bernstein

January 10, 2020
by Julie Parry

In the first Department of Internal Medicine Medical Grand Rounds of the year, “5 + 2 ≠ 7 (The Weekend Effect)” was presented by Chief Resident Ethan Bernstein, MD.

At many hospitals around the country, the 5 + 2 system exists, which can lead to the weekend effect, a 10 to 20 percent increase in all-cause mortality for patients over the weekend when compared to the rest of the week. On Saturdays and Sundays, staffing and services are drastically reduced at many medical facilities.

Bernstein cited an example of a patient at the VA Connecticut Healthcare System in which a patient had to wait until Monday for a test due to a service reduction over the weekend.

“This is not unique to the VA, this happens at Yale New Haven Hospital (YNHH) and all around our country,” explained Bernstein. “In contrast, a seven-day system is one in which every of the week, staffing, access to diagnostics, interventions are largely unchanged.”

Bernstein was born at YNHH when his physician parents, Paul and Tamie, were completing their residencies at the hospital. During his adolescence, he asked his parents, “When does the hospital close?” to which his parents responded, “Never.”

The phenomenon was first observed in the 1970s and a paper in The New England Journal of Medicine in 2001, which concluded that, “Patients with some serious medical conditions are more likely to die in the hospital if they are admitted on a weekend than if they are admitted on a weekday.”

Two studies, one in 2012 and one in 2015 in The BMJ looked at the weekend effect and demonstrated this increase in mortality in the National Health Service (NHS) in the United Kingdom. NHS has since evolved from a 5 + 2 day system to a seven-day system. In a special twist, younger Bernstein shared the stage with his nephrologist father Paul which shared data from JAMA in 2005.

The younger Bernstein would then cite ways in which YNHH functions differently over the weekend and proposed that Yale New Haven Health look at transitioning to a seven-day system, although acknowledging that more data is needed.

“If built de novo, no one would design a healthcare system where staffing didn’t meet demand.”

To learn more about Bernstein’s presentation, review the video from yesterday’s Medical Grand Rounds.

To learn more about the Residency Training Programs within the Section of General Internal Medicine, visit Residency Training Programs.

Submitted by Julie Parry on January 10, 2020