Weekend and public holiday admissions increased the risk of hospital deaths by up to 41 percent

December 09, 2010

Patients treated by Welsh (UK) hospitals for upper gastrointestinal (GI) bleeding were 41% more likely die if they were admitted on a public holiday and 13% more likely if it was at the weekend, according to research in the January issue of Alimentary Pharmacology and Therapeutics.

Researchers who analysed the records of 22,299 people admitted a total of 24,421 times between 1999 and 2007 also found that admissions, but not death rates, were significantly influenced by social deprivation.

"The higher death rates for weekend and public holiday admissions could not be explained by differences in the patients admitted and may be down to reduced staffing levels or delays in investigative procedures such as endoscopy" says study lead Dr Stephen Roberts from the School of Medicine at the University of Swansea, UK.

Upper gastrointestinal bleeding, which can be caused by conditions such as peptic ulcers and gastritis - an inflammation of the stomach lining often caused by alcohol - results in approximately 25,000 hospital admissions a year across the UK. The highest rates reported are in Scotland, with the lowest rates often in southern England.

Key findings of the study, carried out with the Department of Public Health at the University of Oxford, include:



Patients admitted on Fridays and Saturdays were significantly less likely to receive endoscopy than those admitted on other days and those that did receive this investigative procedure faced a longer, median wait of three days. Rates of endoscopy on the day of admission were lower on Saturdays and Sundays.


Over the whole study period, 10% of people died within 30 days of being admitted to hospital, ranging from 0.2% of people aged from 18 to 24 to 20.9% of those aged 85 plus. Dr Roberts says there are a number of possible explanations for increased deaths at weekends and on public holidays. These could include reduced staffing levels that may lead to: "It is very clear from our research that further studies are needed to understand why death rates are much higher at weekends and on public holidays than during the week" concludes Dr Roberts.

Professor Jon Rhodes, President of the British Society of Gastroenterology and an associate editor of the Journal, comments: "The publication of this paper is very timely because the BSG has been co-drafting a report prompted by concerns raised by the National Patient Safety Agency about deaths from GI bleeding. This will suggest that smaller hospitals form networks to provide seven-day endoscopy cover.

The Welsh study shows, however, that this alone may not be sufficient and our society is also pushing hard to promote seven-day consultant cover in hospitals for the major acute specialties, including gastroenterology."

Fellow associate editor Dr Brian Fennerty, President of the American Society for Gastrointestinal Endoscopy, adds: "Sick patients do not always conform to an 8am to 5pm, Monday to Friday work schedule and physicians and facilities caring for patients need to be able to provide the same level of care 24 hours a day, seven days a week for acutely ill individuals. These data implicate our current health care systems as being inadequate for managing acute GI hemorrhage outside of normal hours and call for an analysis as to why the process of care breaks down and what needs to be done to fix it."


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