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The higher mortality rate for weekend hospitalizations should not be
to be used as an indicator of quality of care due to lack of data
before the admission of the patient and the severity of his illness, a new
study conducted at the University of Warwick Medical School has
concluded.
The study was undertaken as part of the high-intensity program
The HiSLAC project (Specialist-directed short-term care), which is a collaboration led by
by the University of Birmingham and funded by the National Institute
for Health Research (NIHR) and brings together a collaboration of
patients, clinicians, researchers and policymakers across the NHS in
England to contribute to the evaluation of various aspects of NHS England's activities
7 day service program.
In this largest review of the scientific literature of the 'weekend
effect "to date, a team led by researchers from Warwick Medical School
and Birmingham examined 68 studies covering data of more than 640 million
hospitalizations around the world and concluded that unlike
common badumptions, higher mortality rates in patients
admitted to the hospital on weekends are unlikely to reflect in the hospital
quality of care, and can be attributed to different criteria of
admit patients and other factors in the community before the hospital
admission.
Dr. Yen-Fu Chen, lead author of the literature review and author
Associate Professor at the University of Warwick, explained: "We have
some evidence that the higher mortality badociated with weekend
admissions are due to the fact that weekend patients are sicker when they are admitted
at the hospital; but evidence as to whether these patients
receive lower care after admission compared to those admitted
weekdays are rare and somewhat conflicting. "
While hospital mortality was 16% higher for weekends
admissions compared to weekday admissions on average they noticed
such a "weekend effect" varied according to the type of admission, the
effect being most pronounced for elective admissions and almost absent
for maternity admissions.
More importantly, they found that the urgency and fragility of
patients at the time of admission, which may affect their risk of
deaths, has not been sufficiently taken into account in most studies
they examined. In a small number of studies where these factors have been taken into account
better controlled, the apparent effect of the weekend tends to decrease.
The study is published today (June 5) in the journal BMJ Open.
In recent years, the focus has been on scaling up as a solution
"Weekend effect". The researchers found little badociation
between differences in staffing levels between weekends and weekdays
differences in hospital mortality between the weekend and the day of the week in the small number of
Studies that have looked into this, and suggest that there are other factors
affecting the mortality that should be deepened.
Dr. Chen added, "The estimated mortality rate after hospitalization
Admission may be influenced by many factors, such as
status on admission, the quality of care received during the course of
hospitalization, as well as issues related to the organization of the leave and the
how the data surrounding the admission was recorded. It means that the
The "signal" of the hospital mortality rate is masked by the "noise" of others
factors and is unlikely to be an accurate measure of quality of care
during admission.
"More evidence of objective measurement of the quality of care and
process, as well as the stories of patients and caregivers about care
they have known, are also crucial. We collect and badyze
additional data on these issues as part of the HiSLAC project. "
University of Birmingham, Professor Julian Bion, Director
The HiSLAC project investigator said, "Fewer patients are admitted
at the hospital on the weekends, and their profiles are different from those
admitted on weekdays: they are sicker and many of them need
admission directly to intensive care.
"It is also likely that elective admissions, usually for surgical reasons
operations, the weekends are those with more urgent issues and more
complex issues that will contribute to higher mortality. These
These factors seem to explain much of the risk of higher mortality at weekends.
admissions.
"That means looking for the cause of the weekend effect
should include the examination of the entire path of the patient, in particular
health services in the community. For example, we know that the weekend
patients are much less likely to be referred by a general practitioner
before coming to the hospital.
"The main thing is not to be discouraged or delayed by the apparent
'Weekend effect' if you need health care on weekends; and provide
comments on your personal care experience or the NHS if
positive or negative, weekdays or weekends. "
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