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Increased risk of death in weekend admissions

Patients admitted to hospital at the weekend have a significant increased risk of death within 30 days of admission, a study finds.

The research analysed all 14.2 million admissions to NHS hospitals in England during the 12 months from April 2009 to March 2010, and for every 100 deaths among patients admitted to hospital on a Wednesday, 116 similar patients admitted on a Sunday would die.

However, the likelihood of patients dying in hospital is less at the weekend than during the week. For every 100 deaths among patients in hospital on a Wednesday, 92 deaths would occur among similar patients already in hospital on a Sunday. The findings are consistent for both emergency and elective admissions.

The results of the analysis in the Journal of the Royal Society of Medicine are also consistent with data from 254 not-for-profit hospitals in the US, despite differences in the organisation and delivery of care between English and US hospitals.

Lead researcher Professor Domenico Pagano of the Quality and Outcomes Research Unit, University Hospital Birmingham Foundation Trust, said: “These results offer conclusive evidence that confirms previous reports of increased 30-day mortality risk for patients admitted to hospital with emergency conditions at the weekend compared with the rest of the week. Previous reports, however, have not accounted for differences in patient characteristics associated with admissions on different days.”

He said several factors that might be associated with the increased risk of death for patients admitted with emergency conditions. Some may be more seriously ill and had they been less ill, would have had their admissions postponed until a week day. He also speculated that there may be aspects of care at the weekend that disadvantage patients, such as reduced or altered staffing and skill mix; reduced availability of diagnostics; and less availability of senior staff to review cases and to be readily available for escalation.

The study also demonstrated an increased mortality risk over the 30 days follow-up for patients admitted electively at weekends compared with similar patients admitted during the week.

Pagano said: “This could be because patients planned to have higher risk elective procedures at the beginning of the week are admitted over the previous weekend. Consequently the risk profile of elective patients admitted at weekends may be different and possibly higher from those admitted during the week.”

The study analysed all deaths within 30 days from admissions, whether in or out of hospital. For emergency cases the ratio of in-hospital to out of hospital deaths is approximately 2:1, similar for admissions at weekends and during weekdays. For elective patients the ratio is 2:1 for those admitted at weekends but is almost reversed to 1:2 for those admitted during the week.

Commenting on the study, Dr Andrew Goddard, Royal College of Physicians director of medical workforce, said: “This study is further evidence that patients admitted at weekends are more likely to die following admission than patients admitted to hospital during the week. There are many reasons for this, but the two most important are that the patients are more ill and there are fewer doctors available.

“The Royal College of Physicians has already called for any hospital admitting acutely ill patients to have a consultant physician on-site for at least 12 hours per day, seven days a week.”

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