National study casts doubt on higher weekend death rate and proposals for seven-day hospital services
A University of Manchester analysis of all patients across England receiving emergency hospital care has shown that, contrary to popular belief, fewer patients die after being admitted to hospital at the weekend compared to during the week. The death rate following a hospital admission at the weekend is higher only because the number of patients admitted to hospital at the weekend is lower.
The NHS is extending hospital services at weekends because it is believed that patients are at higher risk of dying if they are admitted at the weekend. This is based on research showing that the rate of mortality is higher amongst patients admitted to hospital at the weekend, compared to those admitted during the week. It has been assumed, but not demonstrated, that this is due to reduced availability of senior staff and diagnostic services in hospitals at weekends.
However, previous studies have considered only those patients who were admitted to hospital. The new research, conducted by The University of Manchester’s Centre for Health Economics instead looked at all patients attending Accident and Emergency departments between April 2013 and February 2014. Although similar numbers of patients attended A&E each day at weekends and weekdays, hospitals admitted 7% fewer patients at the weekend.
The so-called ‘weekend effect’ is a statistical artefact and extending services will not reduce the number of deaths. Instead, the most likely impact of the planned service extensions will be an increase in the number of less severely ill patients who are admitted at the weekend, further pushing up NHS costs
Professor Matt Sutton led the research, which looked at deaths in hospital within 30 days of admission. He said: “Hospitals apply a higher severity threshold when choosing which patients to admit to hospital at weekends – patients with non-serious illnesses are not admitted, so those who are admitted at the weekend are on average sicker than during the week and more likely to die regardless of the quality of care they receive.
“As a result, the figures comparing death rates at weekends and weekdays are skewed. The NHS has rushed to fix a perceived problem that further research shows does not exist.”
The study, published in the Journal of Health Services Research and Policy, shows that patients attending A&E at the weekend are no more likely to die than patients attending A&E during the week.
Rachel Meacock, lead author of the study, said: “The so-called ‘weekend effect’ is a statistical artefact and extending services will not reduce the number of deaths. Instead, the most likely impact of the planned service extensions will be an increase in the number of less severely ill patients who are admitted at the weekend, further pushing up NHS costs.”
The paper, ‘Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission’, was published in The Journal of Health Services Research and Policy.
Read a blog by the study authors on the Policy@Manchester site.