Higher risk of death for patients admitted to NHS hospitals at the weekend

Research showing that patients admitted to hospital between Friday and Monday are more likely to die than those admitted on weekdays highlights need for improvement to services

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, according to research published in the British Medical Journal (BMJ).

The analysis was carried out by University Hospitals Birmingham NHS Foundation Trust and University College London, and included NHS England national medical director Sir Bruce Keogh. It examined the effect of the hospital admission day on death rates across NHS England hospitals for 2013/2014.

The authors found 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.

This suggests a generalised ‘weekend effect’ which can be partly explained by the reduced support services that start from late Friday and continue throughout the weekend, leading to disruptions on Monday morning, say the authors. There was no significant change in rates for those who were already in hospital prior to the weekend, and the severity of the illness also had no bearing.

Saturday and Sunday admissions were more likely to be emergencies, 50% and 65% respectively, than on weekdays (29%), and the length of stay was found to be 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.

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’.

Paul Aylin from Imperial College London suggests more research is needed to determine the ‘complex’ relationship between staffing levels and services, and patient safety.

The authors stress they do not wish their findings to be used to claim the excess number of deaths could have been prevented simply by having more doctors working at weekends. However, they are urging a review of weekend services to see what could be improved.

Seven-day working has also been a central part of negotiations between the government and doctors about the proposed changes to the standard contract for NHS consultants.

Health secretary Jeremy Hunt announced the government intends to remove a clause in the contract which allows doctors to opt out of non-emergency work at weekends. But figures obtained from freedom of information requests by BMJ Careers show just 1% of consultants have done this.

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