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UK hospital death rate higher for weekend admissions

  • 18 Comments

People are more likely to die if they are admitted to hospital at weekends, a large-scale review of NHS data has reiterated.

Patients are 16% more likely to die if they are admitted on a Sunday than a Wednesday, and 11% more likely to die if they are admitted on a Saturday.

For every 100 deaths following admissions on a Wednesday, 116 occur for admissions on a Sunday - a “significant increased risk”, the researchers said.

It follows a report in November which found patients needing emergency care are almost 10% more likely to die if they are admitted on weekends and are less likely to receive prompt treatment.

The new analysis covered all admissions - more than 14.2 million - to NHS hospitals in England during 2009/10, including both emergency and planned admissions.

It looked at more than 187,300 patient deaths within 30 days of being admitted to hospital.

The researchers found higher death rates if patients went in on a weekend but a slightly lower death rate if people were already in hospital on a weekend.

Being already in hospital on a Sunday led to an 8% reduced risk of dying on that day compared to already being in hospital on a Wednesday.

The medical conditions resulting in the biggest number of in-hospital deaths included pneumonia, congestive heart failure, heart attack, septicaemia, acute renal failure, urinary tract infections and neck or hip fracture.

The experts, including from University College London and the Universities of Birmingham and East Anglia, wrote in the Journal of the Royal Society of Medicine (JRSM): “We identified a significantly higher risk of subsequent in-hospital death during the 30-day follow-up period associated with admission during the weekend (Saturday or Sunday), compared to mid-week days.

“Admission on Tuesday through Friday was associated with the lowest risk of in-hospital death, while admission on Sunday was associated with the highest risk.

“Admission on Saturday was associated with a marked increased mortality (death) risk and admission on Monday was associated with a less, but statistically significant, increased risk.”

Lead researcher Professor Domenico Pagano, from the University Hospital Birmingham Foundation Trust, added: “These results offer conclusive evidence that confirms previous reports of increased 30-day mortality risk for patients admitted to hospital with emergency conditions at the weekend compared with the rest of the week.”

He said several reasons may be behind the findings, including that patients who are seriously ill can find themselves admitted on weekends.

If they were less ill, they would have had their admissions postponed until a week day.

Prof Pagano also said reduced staffing and fewer senior doctors on duty as well as poor access to diagnostic tests on weekends could have an effect. The Department of Health is looking at ways the NHS could provide more services at the weekend, including more tests and consultant cover.

While this will not be imposed, tools such as providing financial incentives for trusts to promote weekend working and incentives for GPs to strike deals with hospitals which deliver care at weekends could be introduced.

As well as publishing data on outcomes for patients, hospitals may be rewarded a small bonus percentage of their income for offering care at weekends.

 

  • 18 Comments

Readers' comments (18)

  • I suspect that the outcomes would be even worse if they looked at Friday night admissions...

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  • this is appalling. at the risk of stating the obvious, the day of the week or the time of day should have no bearing whatsoever on the treatment a patient receives or their survival rate. patients admitted in an emergency do not choose the date, day or time. such an idea is totally irrational and flawed!

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  • Seeing as a lot of hospital services are closed or run on skeleton crew during the weekend, this isn't in the least bit surprising. Calling in someone from home in an emergency always takes time, and time is crucial with medical care. The more prompt a service can be called upon the better.
    Also, the whole "wait & see how it is on Monday" attitude is rife through the NHS. Investigation that would be undertaken immediately in the week are sat on at the weekend. It's time this ended & services are made 24/7.

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  • Melanie Hill | 3-Feb-2012 3:18 pm

    Excellent comment. I wrote the one above yours but two more things now come to mind:

    when I worked in Switzerland in a city university hospital all staff had to live within a certain radius of the hospital so that they were available in an emergency when needed. This was in the statute and was a condition of the employment contract;

    those who took up a career in healthcare have to be prepared to make some sacrifices with their time and that includes being available when needed 24/24 (obviously excluding pre planned holidays when away) no matter what their level. this is the price we all pay. we get off duty and are only disturbed in exceptional circumstances if there is a staff shortage but also have to expect some call duties and availability during unsocial hours.

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  • michael stone

    Anonymous | 3-Feb-2012 12:36 pm

    It is a fair few years since I was inside a hospital, but are you someone who works in one - in the mid 1990s hospitals seemed to almost empty of doctors at weekends !

    By the way, i heard comment about this on R4 this morning, and the outcomes are apparently worse even for planned weekend admissions, not just for weekend emergencies.

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  • Not shocked I work on a ward were during the week there are docs present 9-5 - after 5 and at weekends on call system. Why will patients be at their worst between 9-5, the whole hospital should be open 24/7. Not rocket science.

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  • I am afraid this situation will only get worse with Chief Execs up and down the country trying to make massive savings. When Cameron promised frontline services would not be affected he was either lying or living in cloud cuckoo land.

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  • Sarah Stanley | 4-Feb-2012 12:09 pm

    how will GP commissioning affect this?

    will NICE still be the decider or will GPs have the power to override their decisions?

    will it give GPs more choice or will it limit availability of drugs and treatment even more?

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  • Ms Stanley

    sorry got my webpages mixed up and stupidly answered your comment without scrolling back to the top of the page. My answer was because I thought i was on the page about prostate cancer drugs being too expensive and your comment was about that. Silly me but perhaps you would have some comments on my questions above as well. I think you can see how the problem could also relate to your remark about the situation getting worse, etc.!

    As for your comment above I am sad to agree although I thought the cut backs were to be more to the effect of getting rid of some of the administration and their high salaries in favour of staff more fit for the purpose of actually caring for patients in the NHS.

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  • Anonymous | 3-Feb-2012 3:33 pm

    "those who took up a career in healthcare have to be prepared to make some sacrifices with their time and that includes being available when needed 24/24 (obviously excluding pre planned holidays when away) no matter what their level. this is the price we all pay. we get off duty and are only disturbed in exceptional circumstances if there is a staff shortage but also have to expect some call duties and availability during unsocial hours. "

    No thank you!! The NHS already abuses the good nature of its staff. The price we all pay, and have been paying for years, is too high. Why do people think that we should be slaves to our jobs? We have families and lives of our own. Nursing should not expect to own our rights to a decent life.

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