Weekend effect on hospital mortality rates ‘a major oversimplification’

There has been much debate over the weekend effect, which suggests the mortality rate for patients admitted to hospital at weekends is higher than those admitted Monday to Friday.

But two new studies published in The Lancet suggest the concept may have been over simplified.

The first paper, led by the University of Birmingham, found no association between weekend senior doctor staffing levels and mortality.

Experts gathered data on senior doctor input into emergency admissions at 115 NHS trusts at two time points – Sunday 15 and Wednesday 18 June 2014.

They did find the mortality risk among patients admitted at weekends was higher than on weekdays, carrying an increased risk of 10%.

But when they plotted mortality risk against senior doctor staffing levels, there was no evidence of an association between the two.

Lead author Professor Julian Bion, of the University of Birmingham, said: “To say that lower staffing is the cause for increased mortality is far too simplistic and not supported by the evidence.

“Policy makers should be extremely cautious when attributing the weekend effect directly to the lack of consultants at the weekend.”

The second paper, led by experts from King’s College London and University College London, specifically looked at weekend stroke care.

The study included data from almost 75,000 patients admitted to 199 hospitals in England and Wales between April 2013 and March 2014

There was no difference in 30-day survival for patients admitted during the day at the weekend, compared with during the week, and only very weak evidence that survival was worse for patients admitted overnight compared with those admitted during the day.

Lead author Benjamin Bray, from the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit and University College London, said: “Much of the current discourse on reducing the weekend mortality effect has occurred in the absence of a detailed understanding of why changes in quality of care occur.

“Our study shows that the ‘weekend effect’ is a major oversimplification of the true extent and nature of variations in the quality of care that occur in everyday practice.

“Our findings apply to stroke care in particular but are likely to be reflected in many other areas of health care.

“When solutions come at such a high financial cost, it is imperative that policy-makers, healthcare managers and funders base their decisions on evidence. Simply transferring doctors from weekdays to weekends is highly unlikely to have the intended effect of improving quality of care.”

On Monday, Health Secretary Jeremy Hunt faced a grilling from MPs over the weekend effect – one of the key factors behind the Government’s push for a seven-day NHS which has led to the dispute with junior doctors.

He told the Health Select Committee: ”I am not an academic but I think the mistake for a health secretary is to look at the overwhelming amount of evidence there is of a weekend effect and decide to get off the hook and disputing the methodologies.”

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