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Should we avoid going to hospitals on weekends, holidays, bridges and summer vacations? And today, national holiday? A topic from the health sector says so: the footprint of the so-called weekend effect in hospitals is notable in Google. And also in the medical literature, with scientific evidence about it. But it is a taboo, which is not talked about, it is not reported ... and it is not polemicized, either inside or outside the health field.

And not because it is not a relevant issue: a recent meta-analysis (synthesis of results) of 45 studies carried out in the United Kingdom shows an increase in mortality among patients treated at the weekend, even after taking into account the severity of their diseases , although it is true that the authors suggest that more research is needed. Another article in the US associates care on weekends and holidays with an increase in mortality: in this case, the risk of mortality was 19% higher in patients admitted at the weekend . A study in Denmark, with emergency patients, states that the 30-day mortality rate increased for patients admitted on weekend nights, indicating that the effect was independent of changes in the severity of the disease.

So, in these days of sea and mountains, the question arises: does that so-called weekend effect also occur in Spanish hospitals during summer vacations? Patients (and their families) who have gone through the experience of being (or being) admitted on these dates know how difficult it is to get to talk to doctors, access diagnostic tests and even receive the attention of nurses more or less quickly . Enric Bañeres, general director of the Avedis Donabedian Foundation for healthcare quality, national reference in this area, confirms that on weekends, holidays, bridges and vacations, in general, "let your guard down; services are not at the same level" .

I would not like to have operated on the 14 because [today] is festive and there is a very long bridge

Even more graphic is Josep Arimany, coroner and director of the Area of ​​Professional Responsibility of the Medical Association of Barcelona , a reference team for the profession, which has accumulated a registry of patient claims since 1986. "I would not like to have an operation of 14 August, because 15 is a holiday and there is a long bridge, "he says.

Carina Escobar, president of the Platform of Patient Organizations , lists the problems of these vacation dates: "There is little information for patients and caregivers about where they have to go or what they have to do in case their doctors are on vacation. data on how to proceed in case of urgency or how they should manage foreseeable or unpredictable health problems .... ", denounces. "In addition, in summer there are more accidents, more heat strokes ... and hospitals have to have resources."

In his opinion, at this station "patient safety is not fully guaranteed." To do this, he claims: "We must guarantee resources and also the quality of care, as well as access to the medical history (basic patient data, pathology or pathologies, treatment that follows, etc.) from anywhere, to margin of origin ".

José Miguel Morales, Professor of Health Sciences at the University of Malaga and member of the Chronicity, Dependency, Care and Health Services Group of the Biomedical Research Institute of Malaga (Ibima) , goes a little further: "The context in Hospitals these days is like asking someone who has anemia to donate blood.The problem is that the situation of nursing in Spain is limited.The ratio of nurses per population is shameful, to reach the European average would require 120,000 or 130,000 more, when what we have done is cause an exodus of thousands to the United Kingdom, Germany and Norway. "

What does usually reach public opinion by these dates every year is the massive closure of beds in public hospitals -12,700 in total this year , according to calculations of the Satse nursing union-, something that, apparently, could make it difficult to Pay attention to all the sick people who need it. The closing of beds, especially in hospitals in provincial capitals that are not tourist, is also accompanied by the closing of operating rooms and other services. Is that negative? "Closing beds in summer makes perfect sense because the demand drops and, in addition, there may not be enough staffing; specifically, there may be fewer nurses for beds than necessary," says Bañeres.

Morales believes that closing beds in summer is "inevitable." "If it's not done, it's like running away."

It emphasizes that when the number of patients that a nurse must attend (ratio) increases due to the greater care pressure, mortality, medication errors, nosocomial infections and adverse events (falls, pressure ulcers) are triggered.

Authorized sources of the Ministry of Health and Families of the Junta de Andalucía report that it is this department who decides the master lines to adapt resources to care needs, but the closing or opening of hospital beds is something that is in the hands of territorial managers and delegates. For example, in the centers of Córdoba, Jaén and Sevilla the needs decrease and, therefore, so does the number of beds; while in Huelva, Cádiz and Málaga the needs soar with the large influx of tourism. In Chipiona, for example, the population is multiplied by eight.

Even if there are closed beds for vacations, managers can reopen them immediately if necessary. It should be borne in mind that in the coastal hospitals where the offer of beds is extended, their staff also has to take vacations, so they are forced to hire more staff, both for reinforcement and for substitutions, with problems That implies.

Modoaldo Garrido, first vice president of the Spanish Society of Health Managers (Sedisa) , states that "a community that empties in summer, like Madrid, has to adapt its resources to the needs, which are going to be less, but its hospitals too they have to take the opportunity to paint, replace furniture, fix things ... and they can only do that when they close. "

On holidays and holidays the services are not at the same level

And he adds that, of course, health workers have the right to get rid and go on vacation, although it is difficult to replace: "We cannot have crossed-arm personnel, so closing beds on vacations is a logical planning measure and relevant. Keeping everything open would mean having a lot more eventual staff and that can be a problem, being an inexperienced staff. "

In the case of doctors, the provision during the summer "is subject to the workforce, with the exception of hiring some professionals for emergencies."

Ramón Cunillera, member of the Board of Directors of the Catalan Society of Health Management , agrees with Garrido that, in general, the proportion of nurses / patients "does not move" with the closing of beds, although there are more eventual staff, with the irrigation that entails.

The problem of quality and safety in hospitals on vacations is there and still be, with the cost that this has for patients and for professionals who support suboptimal working conditions, if not thoroughly investigated, is tackled with transparency and palliated as far as possible with specific plans and investments from the competent administrations.

"It is true that many open beds in summer could allow a reduction of waiting lists, but the problem is that there are not enough surgeons working these dates," says Modoaldo Garrido. "It is also true that there is surgical delay, but we are very attentive that neither the urgent nor the important is left behind. It is not good to say it, but hoping no one dies."

The importance of nursing staff in care

The role of nursing in this matter is important. There are very relevant studies in this regard, such as the 'RN4CAST' carried out in 12 countries (Spain among them), with more than 400,000 patients. He showed how an increase in nursing workload increases the probability of death within 30 days after admission by 7%.

On the other hand, the changes associated with the summer period - such as closing beds - can also be detrimental to nurses who are not on vacation. "With the closure of the operating rooms and services to which these professionals are usually attached, there is a shift to other areas where they may have less experience, for example the intensive care unit or the neonatal unit," says José Miguel Morales, Professor of Health Sciences at the University of Malaga.

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