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Why is there an association between outcomes and weekend admissions

The RCP said in 2010 that patients deserve the same quality of urgent care at evenings and weekends as they receive during the week.

We agree with Sir Bruce Keogh, NHS England Medical Director, that we need to reorganise the way we provide services for very ill patients out-of-hours, and the RCP has led the way in doing so with our Future Hospital Programme.

Sir Bruce is right to acknowledge the existing contribution to out of hours care of many of our members, 65% of whom are already working weekends and evenings.

Nearly all hospitals have senior consultant physician cover in the acute medical unit for at least 12 hours every day. For doctors in our medical specialties that are usually involved in treating very sick patients, the percentages are much higher, for example, 84% of stroke physicians, 84% of acute physicians, 80% of renal (kidney) physicians, 73% of geriatric medicine physicians, and 72% of respiratory physicians.

The BMJ research confirms previous work in this area that there is an association between outcomes and weekend admission, however, there is no more detailed evidence or breakdown of the specific reasons for this, so we need more research to find out why.

The causes of increased weekend mortality are complicated, and are unlikely to be just due to the numbers of doctors working at weekends. There is new evidence that not all excess deaths at weekends are avoidable.

In providing a 7-day service for very sick patients we already need much greater provision of support services covering areas such as diagnostics, nursing, therapy, and social services.

We currently have a large number of consultant physician vacancies in key specialties like acute medicine and geriatric medicine, and we will definitely need more physicians in future, including those with more general skills if we are to provide a 7-day service.

We look forward to receiving further detailed plans from the government and NHS England on how they intend to resource and implement the extended services. We owe it to our patients.

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