Recent research indicates that the “weekend effect” is a systematic phenomenon in the quality of healthcare, which impacts upon mortality rates in hospital care internationally.
2,982,570 hospital records from 28 hospitals in England, Australia, the USA and the Netherlands during 2009–2012 were analysed. It was found that mortality outcomes vary with days of week in agreement with previous studies on the weekend effect.
Ruiz, M. Bottle, A. [and] Aylin, PP. (2015). The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week. BMJ Quality and Safety. July 6th 2015. [Epub ahead of print].
There is a related editorial literature review on the “weekend effect” and suggested contributory factors:
Lilford, RJ. [and] Chen, YF. (2015). The ubiquitous weekend effect: moving past proving it exists to clarifying what causes it. BMJ Quality and Safety. June 29th 2015. [Epub ahead of print].
Seven-day working has strong backing from the Department of Health:
Triggle, N. (2015). Doctors: Hunt willing to impose seven-day working. London: BBC Health News, July 16th 2015.
Questioning the Economics of Seven Day Working as a Solution for Elevated Hospital Mortality at Weekends
“Using estimates produced by the NHS Seven Days a Week Forum, the annual cost of implementing seven-day hospital services is estimated to be between £1.07 billion and £1.43 billion. This exceeds the maximum amount that the NHS should spend to eradicate the weekend effect by a factor of 1.5 to 2.4, or between £339 million and £831million”.
Meacock, R. The Economics of Elevated Hospital Mortality at Weekends. [Online]: Office of Health Economics (OHE), July 14th 2015.
This relates to:
Meacock, R. Doran, T. [and] Sutton, M. (2015). What are the Costs and Benefits of Providing Comprehensive Seven-day Services for Emergency Hospital Admissions? Health Economics. August 2015, Vol.24(8), pp.907-12. (Click here to view the PubMed abstract).
September 2015 Updates
A balanced discussion of the pros and cons from Nigel Edwards, Chief Executive of the Nuffield Trust:
Edwards, N. (2015). Seven-day working: the bigger picture. London: BBC Health News (Scrubbing Up), September 4th 2015.
Questions of culture:
Triggle, N. (2015). Is there a Monday to Friday culture in the NHS?. London: BBC Health News, September 5th 2015.
Triggle, N. (2015). NHS Weekend: Action demanded over death risk. London: BBC Health News, September 6th 2015.
This relates to the latest statistical analysis of weekend admissions, survivorship models and discussion of potential implications for service design; which indicates:
- Patients admitted at the weekend are in the highest category of risk of death.
- Patients admitted on Saturday or Sunday have an increased likelihood of death.
- There is an additional risk of death exists for admissions on Mondays and Fridays, extending the weekend effect into those two days.
- An estimated 11 000 extra patients die per year within 30 days from admission occurring between Friday and Monday, compared with admission on the remaining days of the week (although the exact reasons remain unclear).
Freemantle, N. Ray, D. [and] McNulty, D. [et al] (2015). Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ. September 5th 2015; 351: h4596.
Aylin, P. (2015). Making sense of the evidence for the “weekend effect”. BMJ. September 5th 2015; 351: h4652.
More (from Aston University):
Potluri, R. (2015). Is it time to re-appraise the weekend effect? Journal of the Royal Society of Medicine (JRSM). October 2015; 108(10): 382-3.
“Defensive” debate on the political interpretation of independent clinical evidence showing increased mortality in hospitals at weekends:
Jeremy Hunt ‘misrepresented weekend deaths data’. London: BBC Health News, October 22nd 2015.
NHS Improving Quality: Seven Day Services Evidence Base
The NHS Improving Quality (NHS IQ) Seven Day Services Team surveyed health and social care leaders across the country to determine the main enablers and barriers to adopting 7 day working.
Seven day services: an evidence base of enablers for transformation. London: NHS Improving Quality, September 2015.
Earlier: Silly Season?
Commentary and analysis on a heated debate:
Pym, H. (2015). Seven-day NHS – claims and counter claims. London: BBC Health News, August 13th 2015.
Hughes, D. (2015). Government ‘chasing headlines on NHS’, says doctors’ union. London: BBC Health News, August 15th 2015.
Continuing through September 2015:
Pym, H. (2015). Junior doctors plan protests – trouble at hospital mill? London: BBC Health News, September 22nd 2015.