Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study

Research output: Contribution to journalArticle

Authors

  • Cassie Aldridge
  • Julian Bion
  • Amunpreet Boyal
  • Yen-Fu Chen
  • Mike Clancy
  • Tim Evans
  • Alan Girling
  • Joanne Lord
  • Russell Mannion
  • Peter Rees
  • Chris Roseveare
  • Gavin Rudge
  • Jianxia Sun
  • Carolyn Tarrant
  • Mark Temple
  • Sam Watson
  • Richard Lilford
  • HiSLAC Collaborative

External organisations

  • University of Warwick, Coventry CV4 7AL, UK
  • Michael J. Seckl, Imperial College London; Yenting Ngai, Stephen Nash, and Allan Hackshaw, Cancer Research UK and University College London Cancer Trials Centre; Christian H. Ottensmeier, University of Southampton and Southampton University Hospitals, Southampton; Michael Cullen, Queen Elizabeth Hospital Birmingham; Joyce Thompson, Heart of England Birmingham; Gary Middleton, University of Birmingham, Birmingham; Peter Schmid, Brighton and Sussex Medical School, Brighton; Dakshinamoorthy Muthukumar, Colchester Hospital, Colchester; Susan Harden, Cambridge University Hospital, Cambridge; Kate M. Fife, Peterborough City Hospital, Peterborough; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; and Paul Taylor, University Hospital South Manchester, Manchester, United Kingdom.
  • Royal Brompton & Harefield NHS Foundation Trust, London, UK
  • SOUTHAMPTON UNIVERSITY
  • Academy of Medical Royal Colleges Patient Liaison Group, London, UK.
  • Southern Health NHS Foundation Trust, Southampton, UK.
  • University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  • University of Leicester
  • Renal Department, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK. khaiping@doctors.org.uk

Abstract

BACKGROUND: Increased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service.

METHODS: Eligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013-14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile.

FINDINGS: 127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34,350 clinicians surveyed, 15,537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40-58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients admitted at weekends was higher than among those admitted on weekdays (adjusted odds ratio 1·10, 95% CI 1·08-1·11; p<0·0001). There was no significant association between Sunday to Wednesday specialist intensity ratios and weekend to weekday mortality ratios (r -0·042; p=0·654).

INTERPRETATION: This cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions. Further investigation is needed to evaluate whole-system secular change during the implementation of 7 day services. Policy makers should exercise caution before attributing the weekend effect mainly to differences in specialist staffing.

FUNDING: National Institute for Health Research Health Services and Delivery Research Programme.

Details

Original languageEnglish
Pages (from-to)178-186
Number of pages9
JournalThe Lancet
Volume388
Issue number10040
Early online date10 May 2016
Publication statusPublished - 9 Jul 2016

Keywords

  • Cross-Sectional Studies, Emergencies, England, Health Policy, Hospital Mortality, Hospitalization, Hospitals, Humans, Odds Ratio, Personnel Staffing and Scheduling, Physicians, Specialization, State Medicine, Surveys and Questionnaires, Time Factors, Journal Article, Research Support, Non-U.S. Gov't