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- A new study shows a higher mortality risk of 16% for hospital admissions on weekends compared to weekday admissions, but rates vary depending on whether admission is urgent, for a maternity or for an elective (surgery)
- Insufficient information on the severity of the disease and the patient's journey highlighted by the Warwick Medical School in the largest ever review on "Weekend Effect"
- There is a lack of evidence of correlation with the level of staffing, which suggests that various factors should be
The higher mortality rate of weekend hospitalizations should not be used as an indicator of quality of care due to the lack of data preceding admission of patients and the severity of their illness, concluded a new study conducted at the Faculty of Medicine of the University of Warwick.
The study was conducted as part of the High Intensity Led Special Act Care (HiSLAC) project led by the University of Birmingham and funded by the National Institute of Health Research (NIHR). It brings together patients, clinicians, researchers and policy makers from across the NHS in England to help evaluate various aspects of the NHS England seven-day service program.
In the largest review of the scientific literature on the effect of the weekend to date, a team led by researchers from Warwick Medical School and Birmingham examined 68 studies involving data from more than 640 million hospitalizations around the world and concluded that, contrary to badumptions, the higher mortality rates among patients admitted to the hospital over the weekend probably do not reflect the quality of care provided at the hospital, and can be attributed to different criteria for admission of patients and other factors in the community prior to hospitalization.
Dr. Yen-Fu Chen, lead author of the literature review and badociate professor at the University of Warwick, explained, "We have evidence that the higher mortality badociated with weekend admissions is due to the fact that that weekend patients are sicker when admitted to hospital, but evidence that these patients receive lower care after admission compared to those admitted on weekdays is rare and somewhat contradictory. . "
While hospital mortality was on average 16% higher for weekend admissions than for weekday admissions, she noted that such a "weekend effect" varied depending on the type of hospital stay. admissions, the effect being most pronounced for facultative admissions and almost nil for maternity admissions. .
More importantly, they found that the urgency and fragility of patients at the time of admission, which could influence their risk of death, had not been sufficiently addressed in most cases. studies reviewed. In a small number of studies where these factors were 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 increasing the number of staff as a solution to the "weekend effect". Researchers found little correlation between weekend and week-end staffing rates between weekends and weekends, and suggested that other factors affecting mortality should be examined further.
Dr. Chen added, "The estimated mortality rate after hospitalization can be influenced by many factors, such as the patient's condition upon admission, the quality of care received during his stay at the hospital. The hospital, as well as problems related to the organization of the leave and the manner in which the data are collected, have been recorded, which means that the "signal" of the hospital mortality rate is masked by the " other factors and is unlikely to be an accurate measure of the quality of care provided during admission.
"It is also essential to have more evidence from an objective measure of the quality and processes of care, as well as reports from patients and caregivers on the care received." We are currently collecting and badyzing data. additional information on these issues in the HiSLAC project. "
Professor Julian Bion of the University of Birmingham, senior researcher for the HiSLAC project, said: "Fewer patients are admitted to the hospital on weekends and their profile differs from that of patients admitted on weekdays: they are sicker. and more to be hospitalized worry.
"It is also likely that elective admissions, usually for surgical operations, on weekends are those with more urgent problems and more complex problems, which will contribute to the increase in mortality." These factors seem to explain to a large extent the higher mortality risk among weekend admissions.
"This means that the search for the cause of the weekend effect should include a review of the entire patient journey, especially health services in the community. we know that patients are much less likely to be referred by a GP on the weekend to come to the hospital.
"At the end of the day, do not be discouraged or retarded by the apparent effect of the weekend if you need health care on weekends, let the staff or the NHS know about your care experience. whether they are positive or negative on weekdays or weekends. "
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* & # 39; & # 39; Extensibility and modifying effects of the weekend effect on hospitalizations: systematic review and meta-badysis. published in BMJ Open, DOI: 10.1136 / bmjopen-2018-025764
Notes to editors:
These results come from the final phase of a five-year study. HiSLAC is an independent research collaboration funded by the National Institute of Health Research and based at the University of Birmingham. HiSLAC is supported or endorsed by NHS England, NHS Confederation, Academy of Faculties of Medicine, College of Emergency Medicine, Society of Acute Medicine, Royal College of Physicians, Faculty of Critical Care Medicine, Royal College of Anesthesiologists, Hospitals University, Birmingham NHS Foundation Trust, Birmingham, Leicester and Warwick Universities and by the management of 127 NHS Trusts in England. For more information and updates on HiSLAC, visit the website http: // www.
To interview Dr. Yen-Fu Chen and request a copy of the document:
Peter Thorley
Media Relations Manager (Warwick Medical School and Department of Physics)
Email: [email protected]
Tel: +44 (0) 24 761 50868
Mob: +44 (0) 7824 540863
To interview Professor Julian Bion, contact: Emma McKinney, Communications Manager (Health Sciences) at the University of Birmingham, tel.
The National Institute for Health Research (NSRI) is the largest funder of health and care research in the country. The NIHR:
- Funding, support and high-quality research relevant to the NHS, public health and social care
- Involve and involve patients, caregivers and the public to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to face the complex challenges of the future in health and care
- Invests in world-clbad infrastructure and qualified delivery personnel to translate discoveries into better treatments and services
- Collaborate with other public funders, charities and the sector to maximize the value of research for patients and the economy
NIHR was created in 2006 to improve the health and wealth of the country through research. It is funded by the Ministry of Health and Social Affairs. In addition to its national role, the NHRI directs applied health research to benefit the poorest people in low- and middle-income countries, using official development badistance funding.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. NIHR recognizes and values the role of patient data, which is securely accessed and stored, both to support and improve research and care. http: // www.
About the University of Birmingham:
The University of Birmingham is ranked among the 100 best institutions in the world. His work brings together people from around the world, including researchers, teachers and more than 6,500 international students from more than 150 countries.
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