Nav: Home

Standards to iron out 'weekend effect' in English hospitals don't make any difference

November 08, 2017

Findings cast doubt on whether 7 day working will curb excess deaths on Saturdays/Sundays

The introduction of four priority standards for emergency care in hospitals in England has not made any difference to curbing excess deaths on Saturdays and Sundays, known as the 'weekend effect,' reveals the first study of its kind, published online in Emergency Medicine Journal.

The clinical standards, which are based on existing recommendations for best practice from national and international bodies, were introduced in 2015 to reduce the 'weekend effect.'

They focus on the speed and frequency with which patients are seen by senior doctors and their access to diagnostic tests and treatment on seven days of the week. They apply to between nine and 14 specialties.

Compliance with the standards by 2020 is mandatory for all hospitals in England, as part of the move to seven day working, with financial penalties threatened for those unable to meet them.

To find out if the adoption of these standards has lowered weekend death rates, and monitor the progress of seven day working, the researchers looked at the performance of 123 hospital trusts in England.

They used publicly available data on deaths within 30 days of admission to hospital against the four standards in 2015, as well as weekend death rates for the three years from 2013-14 to 2015-16.

Trust performance varied considerably: an average of eight out of nine eligible specialties met the consultant directed intervention standard (90%), and just under five out of 10 (49%) met the consultant review standard.

An average of seven out of 13 (54%) specialties met the ongoing review standard, while nearly 11 out of 14 (76%) met the access to diagnostic services standard.

Analysis of the figures showed that adoption of the four clinical standards wasn't associated with numbers of excess deaths among patients admitted on Saturdays and Sundays.

Nor was there any association between hospital trust performance against any of the four standards and the numbers of excess deaths on weekends or any changes in the weekend effect throughout the three years of the study.

The findings held true even after taking account of potentially influential factors, such as primary and secondary diagnoses, age, sex, level of deprivation, time of year, admission source (usual place of residence or other) or method (emergency or planned) and admissions over the previous year.

This is an observational study so no firm conclusions can be drawn about cause and effect, added to which the researchers analysed the number of specialties that met the standards, rather than which ones did so, and meeting these standards might be more important in some specialties than in others.

But they offer three possible explanations for the lack of associations they found between the standards and excess deaths at weekends.

These include poor quality data supplied by the hospital trusts; that the standards don't reduce excess weekend deaths; or that the weekend effect may be the wrong measure by which to judge the benefits of seven day services.

"These findings cast doubt on whether adoption of seven days clinical standards in the delivery of emergency hospital services will be successful in reducing the weekend effect," write the researchers, who go on to say that they "add to the 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 most needy patients, and may not be the best way of using scarce NHS resources or of increasing the quality of care, they suggest.

They conclude: "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."


Related Emergency Care Articles:

Transportation barriers to care may increase likelihood of emergency surgical intervention
Transportation barriers, such as personal access to a vehicle or public transportation, disproportionally affect minority communities.
Clear will and capacity to help emergency care in crisis
Operators beyond the confines of conventional emergency healthcare are willing and able to assist in a crisis, a University of Gothenburg study shows.
Palliative Care in emergency departments during COVID-19 pandemic
The clinical characteristics and outcomes of patients who received intervention by a COVID-19 palliative care response team are examined in this case series.
Academic emergency departments are always open to all who need care
''Academic emergency departments never deny emergency care to any person.'' That is the statement put forth in a commentary from the Board of Directors of the Society for Academic Emergency Medicine and the Senior Editorial Board of Academic Emergency Medicine journal.
Overuse of emergency room reducible through primary care relationship
Using the case of lead exposure in Flint, Michigan, health economist David Slusky and colleagues found that establishing a relationship with a primary care physician for a child reduced the likelihood parents would take them to emergency rooms for conditions treatable in an office setting.
Providing contraceptive care in the pediatric emergency department
A new study found that two-thirds of female adolescents ages 16-21 seen in a pediatric Emergency Department (ED) were interested in discussing contraception, despite having a high rate of recent visits to a primary care provider.
Elder-friendly care after emergency surgery greatly improves outcomes for older patients
Tailoring care for older patients who have had emergency surgery can reduce complications and deaths, decrease the length of hospital stays and cut down on the need for alternate care at discharge, according to a new study led a University of Alberta researcher.
Dogs reduce distress of patients waiting for emergency hospital care
A visit from a dog can reduce the distress of patients waiting for emergency treatment in hospital, a study by the University of Saskatchewan (USask) shows.
Kaiser Permanente improves emergency care for patients with chest pain
Emergency physicians at Kaiser Permanente hospitals in Southern California reduced hospital admissions and cardiac stress testing by using new criteria to assess the level of risk patients with chest pain have for subsequent cardiac events.
Women less likely to receive geriatric care for emergency hip surgery
More than 70 percent of patients receiving surgery for hip fracture are women, yet they are less likely than men to receive geriatric care during hospitalization, or an anesthesiology consultation before surgery, found a study published in CMAJ (Canadian Medical Association Journal).
More Emergency Care News and Emergency Care Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Warped Reality
False information on the internet makes it harder and harder to know what's true, and the consequences have been devastating. This hour, TED speakers explore ideas around technology and deception. Guests include law professor Danielle Citron, journalist Andrew Marantz, and computer scientist Joy Buolamwini.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at     You can read The Transition Integrity Project's report here.