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Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study.

Aldridge, Cassie and Bion, Julian and Boyal, Amunpreet and Chen, Yen-Fu and Clancy, Mike and Evans, Tim and Girling, Alan and Lord, Joanne and Mannion, Russell and Rees, Peter and Roseveare, Chris and Rudge, Gavin and Sun, Jianxia and Tarrant, Carolyn and Temple, Mark and Watson, Sam and Lilford, Richard (2016) Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. Lancet (London, England), 388 (10040). pp. 178-86. ISSN 1474-547X. This article is available to all HEFT staff and students via ASK HEFT Discovery tool http://tinyurl.com/z795c8c using their HEFT Athens Login.

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Official URL: http://www.thelancet.com/journals/lancet/article/P...

Abstract

BACKGROUND

Increased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service.

METHODS

Eligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013-14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile.

FINDINGS

127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34,350 clinicians surveyed, 15,537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40-58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients admitted at weekends was higher than among those admitted on weekdays (adjusted odds ratio 1·10, 95% CI 1·08-1·11; p<0·0001). There was no significant association between Sunday to Wednesday specialist intensity ratios and weekend to weekday mortality ratios (r -0·042; p=0·654).

INTERPRETATION

This cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions. Further investigation is needed to evaluate whole-system secular change during the implementation of 7 day services. Policy makers should exercise caution before attributing the weekend effect mainly to differences in specialist staffing.

FUNDING

National Institute for Health Research Health Services and Delivery Research Programme.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK HEFT Discovery tool http://tinyurl.com/z795c8c using their HEFT Athens Login.
Subjects: WA Patients. Primary care. Medical profession. Forensic medicine
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Preeti Puligari
Date Deposited: 13 Jan 2017 14:36
Last Modified: 13 Jan 2017 14:36
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1111

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