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Improving surgical care at weekends and evenings

A study by researchers from Imperial College London suggests that there is a higher risk of death for patients who have elective surgery later in the week and at the weekend, compared with those earlier in the week.

Professor Antony Narula, RCS Council member and consultant ENT surgeon, comments on the finding:

The BMJ study is an important piece of research which contributes to the debate around how to improve survival rates following surgery.

It is not acceptable that there should be such a wide variation in the mortality rates following elective surgery, according to the day of the week the operation takes place.

It has long been recognised that the 48-hour period after surgery is critical to a patient’s chances of recovery and today’s study rightly suggests that this is an area which needs further research. If operations are carried out on a Friday, the patient will recover over a weekend when less clinical support is generally available within a hospital.

This reinforces the importance of patients being seen on a daily basis by consultants, and also the need for full clinical support being available seven days a week in hospital to provide the best treatment.

The study outlines five complex procedures that normally require intensive care facilities and are not usually carried out at weekends. The procedures highlighted are high-risk and we believe that further analysis of how hospitals are working is essential to understand the reasons for them taking place at weekends.

Many of the issues raised in the study are explained at length in the Academy of Medical Royal Colleges, publication Seven Day Consultant Present Care, which outlines the medical colleges’ commitment to delivering daily high quality care to patients. Professor Norman Williams, president of the Royal College of Surgeons, is now chairing an expert group which is taking forward specific proposals to improve the care at weekends and evenings.

If detailed analysis of this data confirms the initial findings, the implications of the Working Time Regulations in fragmenting medical and surgical teams and creating multiple patient handovers, needs to be considered.

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One Response to “Improving surgical care at weekends and evenings”

  1. The Wanderer says:

    Easy for a prof of ENT to say, I wonder when he was last in the hospital on call out of hours? Can the NHS afford its consultant staff in at the weekend at 3 hour PAs. Having done so to cover registrars at the weekend working 12 hours Saturday and Sunday uses up all my DCC for the next week, fairly painless way to gain an extra weeks leave, but who will so my list?

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