Hospital Dr News

More consultants would improve weekend care

Patients are less likely to get treated promptly and more likely to die if they are admitted to hospital at the weekend, a report reveals.

Overall, 8.1% of those admitted at weekends died compared to 7.4% from Monday to Friday, once those having elective operations such as hip and knee replacements were discounted, the Hospital Guide – by health information company Dr Foster – suggests.

Doctors’ representatives are pointing to the report as evidence that the government must continue to support growth in consultant numbers.

The report says the chances of survival are better in hospitals that have more senior doctors on site. But some hospitals have too few senior doctors in hospital at weekends or overnight.

The report calls for re-organisation of services to ensure safe care 24/7. Examples of innovation from Poole, London, and Northumbria show this can be done to ensure access to high quality services at any time of day or night, it says. Local A&E departments need to identify the services they can provide safely and link with others to provide the services they can’t.

Hospital Guide provides an assessment of hospitals on four key measures of mortality. Chelsea and Westminster Hospital NHS Foundation Trust stands out as the only hospital with low rates on every measure. At the other extreme, Hull and East Yorkshire Hospitals NHS Trust is notable for consistently high rates, the report claims.

The four measures are:

Hospital Standardised Mortality Ratio (HSMR) – a measure of in-hospital deaths;

Summary Hospital-level Mortality Indicator (SHMI) – a measure of mortality both in-hospital and for deaths outside of hospital within 30 days;

Deaths after Surgery – surgical patients who have died from a possible complication; and

Deaths in low-risk conditions – deaths from conditions where patients would normally survive.

Roger Taylor, director of research and co-founder of Dr Foster, said 19 trusts showed high mortality rates.

“A safe NHS is an NHS that provides care 24/7. This year’s guide shows we are some way from that target with significantly reduced services at weekends and nights,” he said.

“However, fewer people died in 2009 than in any year since the mid 1950s – despite the population being larger and older. A large part of that success is down to improvements in care with in-hospital mortality rates falling steadily over the last 10 years.”

The Hospital Guide also identifies 31 trusts that have an above expected rate for not treating hip fracture patients within the recommended two days of admission.

Commenting on the report, Sir Richard Thompson, president of the Royal College of Physicians, said: “At last we have data that clearly links higher numbers of senior doctors in hospitals at the weekend with lower mortality rates. Over the past 10 years the number of doctors in the NHS has steadily increased and it is therefore not surprising that mortality rates have fallen.

“We must ensure that consultant numbers continue to increase to allow higher levels of staffing at the weekend in all hospitals. The findings support the RCP’s 2010 recommendation that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week. No other duties should be scheduled during this time.”

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One Response to “More consultants would improve weekend care”

  1. Malcolm Morrison says:

    This surely emphasises the need for NHS hospitals to put the care of emergencies (medical, surgicaland, dare one say it, psychiatric) as the number one priority. If the NHS does nothing else, it MUST try to save the lives of the ‘critically’ ill.

    Sadly, it is not only the managers (driven by targets made by politicians) who have concentrated, to much, on the ‘production line’ treatment of elective caeses. Too many senior members of the profession have regarded the ‘out of hours’ care of ’emergencies’ as being the province of ‘juniors’!
    Retired Orthopod

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