Study finds weekend effect is not due to consultant availability

Researchers at the University of Birmingham have found that the cause of the ‘weekend effect’ isn’t down to a lack of available hospital consultants at the weekend. The research comes from a five-year NIHR-funded study looking into this.

According to research carried out over the past two decades, patients admitted to hospitals at weekends are slightly more likely to die than those admitted during the week. This has led to the phenomenon known as the ‘weekend effect’.

One of the causes was thought to be attributed to there not being enough doctors in the hospital at weekends, making healthcare less reliable.

However, the High-intensity Specialist-Led Acute Care (HiSLAC) study, has shown that the weekend effect is due to factors in the community before hospital admissions, which still requires further research.

Julian Bion, Professor of Intensive Care Medicine at the University of Birmingham, and Principal Investigator of the HiSLAC study, explained: “We have known for 20 years that patients admitted to hospitals at weekends have a slightly higher risk of dying than those admitted during the week and the cause was thought to be too few doctors in the hospital at weekends, making health care less reliable, but there was no evidence to prove this. Instead, our work suggests the weekend effect is caused by differences in case-mix, which are probably attributable to a reduction in community services at weekends.”

In 2013, NHS England launched a 7-day services policy to improve weekend access to healthcare. This included standards requiring hospital consultants to be more closely involved in caring for patients admitted as emergencies every day of the week, including weekends.

Mr Bion explained: “This research is important for patients and for NHS strategy because it offered a unique opportunity to evaluate the impact of the transition to seven-day working, and to understand factors likely to impede or enhance the effectiveness of this change in practice.”

The study also found:

  • Patients admitted at weekends were typically sicker, frailer, and less likely to have been referred to hospital by their general practitioner. These findings have worsened over the last five years. 
  • The quality of care in hospital is slightly better at weekends than on weekdays and has improved with time. 
  • There are now more specialists in hospital at weekends and on weekdays, but this has been outstripped by the rise in emergency admissions. 
  • Increasing the number of specialists may be cost-effective, not in preventing the ‘weekend effect’, but by promoting earlier discharge of patients from hospital.

The HiSLAC study was a collaborative approach involving doctors and patients, and all acute hospitals in England, to evaluate whether the ‘7-day services’ policy would improve care and minimise the weekend effect.

The team conducted searches of existing research, surveyed specialists about their working patterns; interviewed hospital staff and patients about their experiences; looked at whether introducing more specialists was good value for money; and studied national trends, including how many patients died in hospital or shortly after discharge. 

The study used a team of 81 doctors to review 4,000 anonymised emergency admission patient records from 20 hospital trusts to look at quality of care.

Julian Bion concluded: “Policy-makers should focus their efforts to improve acute and emergency care on a ‘whole-system’ seven-day approach that integrates social, community and secondary health-care resources, organisation and delivery - it is the whole patient pathway, which is of interest, not just isolated segments.”

They are also calling for more studies into how social and community care contributes to the phenomenon.

The study can be found in the Health Services and Delivery Research in NIHR’s Journals Library.

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