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Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays.

Bion, Julian and Aldridge, Cassie P and Girling, Alan and Rudge, Gavin and Beet, Chris and Evans, Tim and Temple, R Mark and Roseveare, Chris and Clancy, Mike and Boyal, Amunpreet and Tarrant, Carolyn and Sutton, Elizabeth and Sun, Jianxia and Rees, Peter and Mannion, Russell and Chen, Yen-Fu and Watson, Samuel Ian and Lilford, Richard (2017) Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays. BMJ open, 7 (12). e018747. ISSN 2044-6055. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: http://bmjopen.bmj.com/content/7/12/e018747

Abstract

INTRODUCTION

The mortality associated with weekend admission to hospital (the 'weekend effect') has for many years been attributed to deficiencies in quality of hospital care, often assumed to be due to suboptimal senior medical staffing at weekends. This protocol describes a case note review to determine whether there are differences in care quality for emergency admissions (EAs) to hospital at weekends compared with weekdays, and whether the difference has reduced over time as health policies have changed to promote 7-day services.

METHODS AND ANALYSIS

Cross-sectional two-epoch case record review of 20 acute hospital Trusts in England. Anonymised case records of 4000 EAs to hospital, 2000 at weekends and 2000 on weekdays, covering two epochs (financial years 2012-2013 and 2016-2017). Admissions will be randomly selected across the whole of each epoch from Trust electronic patient records. Following training, structured implicit case reviews will be conducted by consultants or senior registrars (senior residents) in acute medical specialities (60 case records per reviewer), and limited to the first 7 days following hospital admission. The co-primary outcomes are the weekend:weekday admission ratio of errors per case record, and a global assessment of care quality on a Likert scale. Error rates will be analysed using mixed effects logistic regression models, and care quality using ordinal regression methods. Secondary outcomes include error typology, error-related adverse events and any correlation between error rates and staffing. The data will also be used to inform a parallel health economics analysis.

ETHICS AND DISSEMINATION

The project has received ethics approval from the South West Wales Research Ethics Committee (REC): reference 13/WA/0372. Informed consent is not required for accessing anonymised patient case records from which patient identifiers had been removed. The findings will be disseminated through peer-reviewed publications in high-quality journals and through local High-intensity Specialist-Led Acute Care (HiSLAC) leads at the 121 hospitals that make up the HiSLAC Collaborative.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: W Public health. Health statistics. Occupational health. Health education
WB Practice of medicine
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 29 Dec 2017 13:26
Last Modified: 29 Dec 2017 13:26
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1571

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