Jeremy Hunt, the UK Health Minister, has launched a campaign to increase the number of NHS Staff who work at the weekend. His principle reason for this initiative is that a study, "Weekend hospitalization and additional risk of death: An analysis of inpatient data." appears to show that there is a significantly greater risk of death for patients admitted at the weekend than for those admitted during the week. A patient admitted on a Sunday has a 16% greater risk of death than normal.
The headlines seem to support the clamour for full 7 day working in the NHS. (See BBC: Jeremy Hunt: 'We have 6,000 avoidable deaths every year'). However, this is not the case and the media have got hold of the wrong end of a long and bent stick. Lets look closer at the study. The study had the following conclusion:
"Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day"
The study showed that although patients who were admitted at weekends had a higher risk of death than normal they actually tended to die midweek. Why? The study has some further evidence and suggestions:
"These findings are consistent for emergency and for elective admissions." so the increased death rate was not due to increased risky behaviour at the weekend.
As far as emergency admissions are concerned the study suggested that there could be bias introduced by patients themselves: "The cohort of patients admitted during the weekend will include those patients who would otherwise, had they been less ill, have had their admission postponed until a week-day." This is a promising reason, no-one, staff or patients, wants to be admitted at the weekend unless it is totally necessary.
Elective admissions, ie: those whose admissions have been planned ahead, also showed higher death rates if the admission were at the weekend. The study gave strong evidence that this was because only serious cases would be admitted at the weekend:
"Our study analysed all deaths within 30 days from admission, whether the event occurred in or out of hospital. For emergency cases, the ratio of in-hospital to out of hospital deaths is approximately 2:1, and this is similar for admissions at weekend and for those during the week-days. For elective patients this ratio is 2:1 for those admitted at weekends but is almost reversed (1:2) for those admitted during the week. This suggests that the risk profile of elective patients admitted at weekends may be different and possibly higher from that of those admitted during the week."
Overall the study gives no clear evidence that the increased risk of death if a patient is admitted at the weekend is actually due to a lack of 7 days a week working. It seems to be more an artefact of the existence of weekends rather than caused by poor care at weekends - after all, although admitted at the weekend the patients died during the week.
Reference:
Freemantle N, Richardson M, Wood J, et al. Weekend hospitalization and additional risk of death: An analysis of inpatient data. Journal of the Royal Society of Medicine. Published online on February 2 2012 http://jrs.sagepub.com/content/105/2/74.full.pdf+html
Twitter, use http://tinyurl.com/p8o2smk
The headlines seem to support the clamour for full 7 day working in the NHS. (See BBC: Jeremy Hunt: 'We have 6,000 avoidable deaths every year'). However, this is not the case and the media have got hold of the wrong end of a long and bent stick. Lets look closer at the study. The study had the following conclusion:
"Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day"
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| In the UK NHS People Die on Wednesday |
The study showed that although patients who were admitted at weekends had a higher risk of death than normal they actually tended to die midweek. Why? The study has some further evidence and suggestions:
"These findings are consistent for emergency and for elective admissions." so the increased death rate was not due to increased risky behaviour at the weekend.
As far as emergency admissions are concerned the study suggested that there could be bias introduced by patients themselves: "The cohort of patients admitted during the weekend will include those patients who would otherwise, had they been less ill, have had their admission postponed until a week-day." This is a promising reason, no-one, staff or patients, wants to be admitted at the weekend unless it is totally necessary.
Elective admissions, ie: those whose admissions have been planned ahead, also showed higher death rates if the admission were at the weekend. The study gave strong evidence that this was because only serious cases would be admitted at the weekend:
"Our study analysed all deaths within 30 days from admission, whether the event occurred in or out of hospital. For emergency cases, the ratio of in-hospital to out of hospital deaths is approximately 2:1, and this is similar for admissions at weekend and for those during the week-days. For elective patients this ratio is 2:1 for those admitted at weekends but is almost reversed (1:2) for those admitted during the week. This suggests that the risk profile of elective patients admitted at weekends may be different and possibly higher from that of those admitted during the week."
Overall the study gives no clear evidence that the increased risk of death if a patient is admitted at the weekend is actually due to a lack of 7 days a week working. It seems to be more an artefact of the existence of weekends rather than caused by poor care at weekends - after all, although admitted at the weekend the patients died during the week.
Reference:
Freemantle N, Richardson M, Wood J, et al. Weekend hospitalization and additional risk of death: An analysis of inpatient data. Journal of the Royal Society of Medicine. Published online on February 2 2012 http://jrs.sagepub.com/content/105/2/74.full.pdf+html
Twitter, use http://tinyurl.com/p8o2smk
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