The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-29.
To ask Her Majesty’s Government whether they will publish all evidence they have available on the mechanism whereby increasing the presence of consultants and diagnostic tests at weekends will result in lower mortality and reduced length of stay.
Lord Prior of Brampton
The Department published a summary of the research examining the association between weekend hospital admissions and poorer patient outcomes, including higher rates of mortality, on 15 October 2015 on the gov.uk website. A range of potential causal links for this association have been identified; one of these is the availability of staff and services at weekends.
The following studies were published on the gov.uk website at the following address:
https://www.gov.uk/government/publications/research-into-the-weekend-effect-on-hospital-mortality/research-into-the-weekend-effect-on-patient-outcomes-and-mortality
Of these, the following four articles are published in academic journals and are only available by subscription.
Freemantle et al (2015), BMJ 2015; 351:h4596, Increased mortality associated with weekend hospital admission: a case for expanded seven day services?
Independent research that analysed 2013 to 2014 hospital episodes statistics (HES) data found:
– although there are fewer hospital admissions at weekends, patients who are admitted on Saturday and Sunday are sicker and face an increased likelihood of death within 30 days, even when severity of illness is taken into account;
– patients admitted on a Sunday have a 15% greater risk of mortality compared to those admitted on Wednesday;
– patients admitted on a Saturday have a 10% greater risk of mortality compared to those admitted on a Wednesday;
– there are around 11,000 excess deaths in hospitals every year among patients admitted on a Friday, Saturday, Sunday or Monday compared with other days of the week. The authors included the effect of Fridays and Mondays as ‘appropriate support services in hospitals are usually reduced from late Friday through the weekend, leading to disruption on Monday morning’;
– oncology patients admitted on a Sunday have a 29% increased risk of death compared to those admitted on a Wednesday; and
– patients with cardiovascular disease admitted on a Sunday have a 20% increased risk of death compared to those admitted on a Wednesday.
The study concluded that it is not possible to determine how many of the excess deaths were avoidable, but that the statistic is ‘not otherwise ignorable’ and ‘raises challenging questions about reduced service provision at weekends’.
The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week, BMJ Qual Saf Published Online First 6 July 2015, doi:10.1136/bmjqs-2014-003467
The Global Comparators dataset collects inpatient records across 50 hospitals in 10 countries. Analysis of a sub-sample of this data (28 hospitals across England, Australia, United States of America and Netherlands) for emergency admissions showed:
– there is an overall 30-day crude mortality rate of 3.9%; the English hospitals had the highest crude morality rate (4.6%); crude mortality rates for the English, Dutch and USA hospitals were higher at weekends compared with weekdays; and
– emergency patients in the English, USA and Dutch hospitals showed a significantly higher adjusted risk of death within 30 days following admission on a Saturday or Sunday compared with admission on a Monday.
This study did not show a difference in mortality within 30 days for patients admitted at weekends in Australian hospitals. However, when analysing mortality within seven days, the Australian hospitals showed 12% higher risk of death when admitted on a Saturday compared to a Monday, and 11% higher risk of death following a Sunday admission.
Freemantle et al (2012), J R Soc Med. 2012 Feb;105(2):74-84, Weekend hospitalisation and additional risk of death: an analysis of inpatient data
Analysis of 2009 to 2010 HES data found:
– patients admitted to hospital on a Sunday had a 16% greater risk of death within 30 days compared to those admitted on a Wednesday;
– patients admitted on a Saturday had an 11% increased risk of death within 30 days compared to those admitted on a Wednesday;
– day of admission was associated with increased risk of death in seven of the 10 most common CCS groups (clinical conditions), for example:
– patients admitted on a Sunday with acute and unspecified renal failure had a 37% increased risk of death compared with those admitted on a Wednesday; and
– patients admitted on a Sunday with acute myocardial infarction had an 11% increased risk of death compared to those admitted on a Wednesday.
Aylin et al (2010), Qual Saf Health Care 2010; 19:213-217, Weekend mortality for emergency admissions: a large multicentre study
This was one of the first, large scale studies of English data to explore weekend mortality rates for emergency admissions.
Using the data for financial year 2005 to 2006, the study found:
– crude mortality rates are higher for patients admitted at weekends compared to weekdays (5.2% for all weekend admissions; 4.9% for all weekday admissions; overall crude mortality rate: 5.0%);
– there is a 10% higher risk of death for patients admitted as an emergency at the weekend compared with those admitted on a weekday; and
– there may be a possible 3,369 excess deaths occurring at the weekend compared to weekdays (equivalent to a 7% higher risk of death).
East Midlands Clinical Senate (2014), 7 Day Services Report: Acute Collaborative Report
Ten East Midlands acute trusts undertook a data gathering exercise to look at current provision against the 10 clinical standards for urgent and emergency care that underpin consistently high quality care 7 days a week. A copy of this report is attached.
NHS Services, Seven Days a Week Forum (2013), was a clinically-led process which included an extensive review of the published literature alongside analysis of HES data to explore patient outcomes at weekends compared to during the week. A copy of this report is attached.
Academy of Medical Royal Colleges (2012), seven day consultant present care.
In light of evidence demonstrating less favourable patient outcomes at weekends compared to weekdays, the Academy of Medical Royal Colleges presented proposals for achieving parity for inpatient care throughout the week. A copy of the report is attached.
