Tag Archives: weekend addmissions

‘Weekend effect’ blamed for 11,000 extra deaths in hospital each year

Up to 11,000 more people die each year after being admitted to hospital over the weekend compared with other days of the week, a major study suggests.

The disclosure comes days before a deadline for doctors’ unions to agree changes to consultants’ contracts, in an attempt to increase levels of weekend cover, or see them imposed.

The study of 15 million hospital admissions, published in the BMJ, found a significant “weekend effect” for patients admitted between Friday and Monday.

The figures stand in contrast to estimates by Jeremy Hunt, the Health Secretary, who said in July that the number of extra deaths during weekends was 6,000 a year.

Overall, patients admitted on Saturday or Sunday – when staffing levels and access to backup services are reduced – were twice as likely to die within 30 days of surgery, the study found.

Some of these deaths were because patients admitted at weekends are likely to be sicker, given that less hospital treatment routinely takes place during this period. The study showed that even when this was taken into account, those who were admitted to hospital at the weekend were still significantly more likely to die.

The highest death rates were among those admitted on Sunday, with 15 per cent more deaths, once figures were risk adjusted, and 10 per cent more on Saturday.

Overall, that amounts to an extra 11,000 deaths a year among those admitted between Friday and Monday.

Prof Sir Bruce Keogh, NHS medical director and one of the authors of the landmark study, said it revealed an “inconvenient truth” that could no longer be ignored and required an overhaul in the way services are run.

The research, by University Hospital Birmingham NHS Foundation Trust and University College London, examined the effect of the hospital admission day on death rates across NHS England hospitals for 2013-14.

Prof Keogh said: “The idea that patients are being harmed because of the way we organise our services is quite simply beyond what any of us can regard as acceptable. The moral and social case for action is simply unassailable.”

“Change always brings practical difficulties that must be tackled but we cannot duck the facts,” said Prof Keogh. “It is my job here to point out an inconvenient truth: doctors are trying their best but I have to think about the way that we can redesign services to address this issue.”

Overall, mortality rates from Tuesday to Thursday were 1.6 per cent, creeping up to 1.75 per cent on Friday, 2.64 per cent on Saturday and 3.4 per cent for those admitted on a Sunday, before dropping back to 1.7 per cent by Monday, the figures show.

The research said: “Appropriate support services in hospital are usually reduced from late Friday through the weekend, leading to disruption on Monday morning. This could go some way towards explaining our finding of a ‘weekend effect’ extending into Friday and Monday.”

The Royal College of Surgeons said patients needed better access to senior staff and key tests at weekends.

Its president, Clare Marx, said: “Patients who need treating at the weekend are less likely to be seen by the right mix of junior and senior staff, and experience reduced access to diagnostics. Many doctors and NHS staff already work at night and weekends, and they should be valued and thanked for continuing to provide care during those unsocial hours.

“However, the evidence shows this is not currently standard practice, even in high-risk emergency care. This has to change.”

Last week an investigation by The Telegraph found that in some specialties there were six times as many consultants working during the week as at weekends.

Even in accident and emergency departments, there were twice as many senior doctors working during the week as at weekends, despite demand for services being consistent throughout the week, with only a small spike in admissions on Mondays.

A study of heart attack patients presented to cardiologists last week found those who were admitted on Saturday had death rates 20 per cent higher than those who arrived at hospital during the week.

The BMA has been given a deadline of Friday to agree changes to consultants’ contracts – with the removal of the right to opt out of non-emergency weekend work – or see changes imposed.

Dr Mark Porter, chairman of the BMA, has accused the Government of failing to provide detailed plans, and said weekday services would be damaged if doctors were spread too thinly.

“Doctors want the care we provide for sick patients to be of the same high standard, seven days a week,” he said.

“Urgent action on this has been undermined by calls for the entire NHS to be delivered on a seven-day basis without any clear prioritisation.

“The BMA wants better access to seven-day urgent and emergency care to be the priority for investment. This will ensure seriously ill patients receive the best care at all times.”

He said as well as extra doctors, there needed to be investment in more nurses and diagnostic and support staff.

“Given the current funding squeeze on NHS trusts, the only way for many hospitals to increase the number of doctors over the weekend would be to reduce the number providing care during the week.”

Source The Telegraph