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Hospital care standards 'not reducing weekend patient deaths'

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Standards for emergency care aimed at ironing out the “weekend effect” do not appear to have made any difference to the number of excess deaths on Saturdays and Sundays, according to a new study.

Researchers behind the study, published online in the Emergency Medicine Journal, say their findings cast doubt on whether seven-day working in the NHS will cut higher mortality rates at the weekend.

“[These findings] add to an increasing body of evidence questioning the link between levels of service provision and weekend death rates”

University of Manchester research on new care standards

They set out to explore the impact of four priority standards for emergency care introduced in hospitals in England in 2015 with the aim of boosting the speed and frequency patients were seen by senior doctors and ensure access to diagnostic tests.

All hospital trusts must comply with these standards, which apply to up to 14 different specialities, by 2020 as part of the move to seven-day working with financial penalties threatened for those who do not meet them.

Researchers from the Manchester Centre of Health Economics at the University of Manchester looked at the performance of 123 hospital trusts in England.

They matched this with information on deaths within 30 days of admission in 2015 as well as weekend death rates from 2013/14 to 2015/16.

The analysis shows wide variations in performance between trusts and when it came to overall national performance on each of the four standards.

On average eight out of nine – 90% - of eligible specialities at each trust met the standard to ensure patients had 24/7 access to “consultant-directed intervention”.

“The four priority clinical standards should be reviewed before compliance for all NHS hospitals is mandated in 2020”

University of Manchester research on new care standards

However, just under five out of 10 – 49% - met the standard to ensure patients were seen by a consultant as soon as possible or within 14 hours of arriving at the very latest.

An average of seven out of 13 – 54% - of specialities ensured patients were seen and reviewed by a consultant at least twice a day while nearly 11 out of 14 – 76% - of specialities met the standard for access to diagnostic services.

Analysis of the figures showed adoption of the four clinical standards was not linked to the number of excess deaths among patients admitted on Saturdays and Sundays.

There was also no association between trust performance on any of the four standards and weekend death rates, or changes in the “weekend effect”, over three years.

The research team found this was true even when other factors that could influence death rates were taken into account.

However, their analysis only looked at the overall number of specialities that met the standards rather than looking at exactly which specialities were achieving the four key goals.

“[There is a] lack of association between the stated aims of the seven day services policy and the clinical standards being introduced”

University of Manchester research on new care standards

Meeting the standards might be more important in some specialities than others, the researchers said in the paper, called Elevated mortality among weekend hospital admissions is not associated with adoption of seven day clinical standards.

Possible explanations for the fact the standards do not appear to have much impact could include poor quality data supplied by trusts.

The findings might also mean the standards simply don’t work when it comes to reducing higher mortality rates at weekends or that looking at the “weekend effect” is the wrong way to judge the benefits of seven-day working.

The researchers said the findings “add to an increasing body of evidence questioning the link between levels of service provision and weekend death rates”.

Complying with the standards may also divert care away from the sickest patients and may not be the best way to use NHS resources or improve the quality of care, they warned.

“The lack of association between the stated aims of the seven day services policy and the clinical standards being introduced to meet these aims suggests that the four priority clinical standards should be reviewed before compliance for all NHS hospitals is mandated in 2020,” concluded the paper.

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