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Weekend admissions are more likely to have higher risk of death, analysis shows

Patients admitted to hospital at the weekend are more likely to be sicker and have a higher risk of death, compared with those admitted during the week.

This is conclusion of an analysis published in The BMJ this week.

The authors say that around 11,000 more people die each year within 30 days of admission to hospital on Friday, Saturday, Sunday, or Monday compared with other days of the week (Tuesday, Wednesday, Thursday).

The analysis was carried out as a collaboration between University Hospital Birmingham NHS Foundation Trusts and University College London, and included Sir Bruce Keogh, National Medical Director of NHS England.

It examined the effect of hospital admission day on death rates across NHS England hospitals for 2013-2014. The results confirm findings from an analysis they undertook for 2009-2010.

The analysis says there is a generalised “weekend effect” which can be partly explained by the reduced support services that start from late Friday through the weekend, leading to disruption on Monday morning, say the authors.

Patients already in hospital over the weekend do not have an increased risk of death.

These results remained the same even when taking into account the severity of illness.

The authors caution that it is not possible to show that this excess number of deaths could have been prevented, adding that to do so would be “rash and misleading.”

Nevertheless, the lead author Prof Domenico Pagano, clinical director of the Quality and Outcomes Research Unit, University Hospitals Birmingham NHS Foundation Trust, said the number is “not otherwise ignorable” and “we need to determine exactly which services need to be improved at the weekend to tackle the increased risk of mortality.”

An average of 2.7 million patients were admitted to hospital on each weekday, while an average of 1.2 million patients were admitted on a Saturday and 1 million patients admitted on a Sunday.

Saturday and Sunday admissions were more likely to be emergencies, 50% and 65% respectively, than on weekdays (29%) and length of stay was also higher for patients admitted on a Saturday and Sunday.

A higher proportion of patients admitted on a Saturday and Sunday had diagnoses that placed them in the highest risk of death category, 24.6% and 29.2% respectively, compared with less than 20% of weekday admissions.

It reignites the debate on seven day working following health secretary Jeremy Hunt’s recent call for hospital doctors to work at weekends to improve quality of care and reduce deaths.

NHS England Medical Director Sir Bruce Keogh said: “Doctors up and down the country routinely go the extra mile, well beyond any contractual duty, to save and improve lives. But 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 and there is widespread clinical consensus about that. Change always brings practical difficulties that must be tackled but we cannot duck the facts.”

An accompanying article by Helen Crump at the Nuffield Trust says it is not clear how or to what extent investment in seven day services will reduce weekend deaths, and that the costs may outweigh any benefits.

She also warns that, unless overall staffing levels increase, ramping up services at the weekend “will leave a gap in the hospital’s weekday rota, with potentially serious consequences across other services.”

Seven day working has been a central part of negotiations between the government and doctors about proposed changes to the standard contract for NHS consultants. Hunt announced that the government would remove a clause in the contract which allowed doctors to opt out of non-emergency work at weekends.

But figures obtained from freedom of information requests show that just 1% of consultants have opted out of non-emergency weekend work.

Dr Mark Porter, BMA council chair, commented: “If the government really want to deliver more seven-day services then they need to show patients, the public and NHS staff their plan for how this will be delivered at a time of enormous financial strain on the NHS and when existing services and staff are under extreme pressure.”

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