Any statisticians here?

Weekend mortality for emergency admissions. A large, multicentre study

Background Several studies have identified higher mortality for patients admitted as emergencies at the weekend compared with emergency admissions during the week, but most have focused on specific conditions or have had a limited sample size.

Methods Using routinely collected hospital administrative data, we examined in-hospital deaths for all emergency inpatient admissions to all public acute hospitals in England for 2005/2006. Odds of death were calculated for admissions at the weekend compared to admissions during the week, adjusted for age, sex, socioeconomic deprivation, comorbidity and diagnosis.

Results Of a total of 4 317 866 emergency admissions, we found 215 054 in-hospital deaths with an overall crude mortality rate of 5.0% (5.2% for all weekend admissions and 4.9% for all weekday admissions). The overall adjusted odds of death for all emergency admissions was 10% higher (OR 1.10, 95% CI 1.08 to 1.11) in those patients admitted at the weekend compared with patients admitted during a weekday (p

from the BMJ.

Another one...


Background A number of studies have shown that weekend admissions to hospital are associated with significantly higher mortality compared with weekday admissions. Previous studies have suggested that the observed variability in weekend-weekday mortality is a consequence of the quality of care provided in hospital. However, little information exists on whether the increased mortality associated with weekend admission is explained by the relative severity of illness at the time of admission.


Methods We performed a retrospective analysis of all emergency acute care admissions in England between April 2009 and March 2010 using Hospital Episode Statistics data. In-hospital mortality among patients who were admitted as emergency admission on weekends as compared to weekdays was analysed using the following measures: (1) overall deaths in hospital; (2) deaths in hospital within and after 3 days of admission (3) deaths in hospital among patients with ‘higher risk’ conditions and ‘lower risk’ conditions. The ‘higher risk’ conditions consisted of 103 Primary Diagnosis codes (ICD–10), which accounted for the 74% of in-hospital deaths in the UK. The remaining Primary Diagnosis codes were categorised as ‘lower risk’ conditions.


Results There were 10,221,500 emergency hospital admissions during the two-year study period; 23.8% of the patients were admitted on weekends. A total of 391,938 patients died in hospital; a quarter of these died within 3 days of admission. Admission on weekends was associated with significantly higher in-hospital deaths as compared to weekday admission (Odds Ratio 1.11, 95% CI 1.10–1.12). Mortality within 3 days of admission (early deaths) was also higher for patients admitted on weekends (OR 1.16, 95%CI (1.14–1.17) and this difference persisted for both ‘higher risk’ and ‘lower risk’ conditions. However, when early deaths were excluded from the analysis, mortality was not affected by weekend admission.


Conclusion Higher mortality was seen among patients admitted on weekends compared to those admitted on weekdays. However, as the odds ratio for deaths after 3 days of admission was not affected by day of admission, it is probable that the weekend admission effect on mortality is at least in part due to higher severity of illness at the time of admission rather than purely being a consequence of poorer quality of in hospital care at the weekend, and this warrants further investigation.

so there is a difference, and no body knows why. Could be that its the weekend, ie people behaving differently not at work, who knows.

What must be plain is that to use these figures to bash junior doctors is just plucking a reason out their arse

Thank you Clydebank, I will reread your postings once I have looked up comorbidity.
5.2% compared to 4.9% is considerable unless the weekend starts at 5 pm Friday and ends at 9am Monday.

Those figures are for two years at most and the difference is not much more than 2%.

You may find this useful, an updated evaluation and commentary:

08 / 09 / 2015
Seven-day services – analysis and commentary
British Medical Journal, September 2015
Nick Freemantle and colleagues (including Sir Bruce Keogh) have published an updated evaluation of weekend admissions, following a previous study of cases for 2009-10. This new piece of research looked at more than 14.8 million admissions in 2013-14, with the article highlighting that admissions on a Saturday and a Sunday only amounted to eight and six per cent respectively of all cases reviewed.

It is noted that not only were 50 per cent of Saturday admissions and 65 per cent of Sunday admissions found to be emergency cases, but also the “cohort admitted at weekend included a greater prevalence of patients with higher predicted mortality risk than those admitted during the week.” Thirty-day mortality across all admissions for 2013-14 was found to be 1.8 per cent, with the relative risk of death within that timescale judged to increase by 10 per cent (i.e. 1.98 per cent mortality) for a Saturday admission and 15 per cent (i.e. 2.07 per cent mortality) for a Sunday admission. Freemantle et al confirm that their 2013-14 findings were “qualitatively similar to the corresponding results from our previous analyses”, which found relative risk increased by 11 and 16 per cent respectively.

The article also considers the impact of weekend admission for those with cardiovascular disease and oncological conditions (“similar results” overall, although it is noted that for the latter group, there was also an increased risk on Mondays and Fridays). Freemantle et al suggest there is now “a more generalised ‘weekend effect’” covering Fridays and Mondays, with around 11,000 extra deaths annually found for cases admitted over that four-day period in 2013-14. Other conclusions from the study include:

Patients admitted over the weekend judged to be at the highest risk of predicted mortality have a longer length of stay if they survive the initial episode of care than those with similar conditions admitted during the week.
The researchers do confirm “It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.” Nevertheless they also stress that the ‘weekend effect’ is “not otherwise ignorable.”
Freemantle et al are unequivocal that patients “should never have to accept an increased risk because of the way healthcare services are designed and delivered.”
The BMJ has simultaneously published an editorial, feature and observation piece about the seven-day working issues.

In his editorial, Professor Paul Aylin argues that research contradicting studies akin to the above “tend to be smaller, carried out in single hospitals, and lack statistical power.” He emphasises the distinction between ‘relative risk’ and ‘attributable risk’, while also noting the evidence pointing to a “weekend increase in avertible errors in care leading to other complications.” The article cites research that Aylin himself was involved in, which found an increasing mortality risk from planned procedures as the week progressed and that the care received by emergency stroke patients at weekends was often lacking crucial elements, e.g. thrombolysis and prompt computed tomography. He concludes by advocating a “comprehensive systematic review” of studies into the ‘weekend effect’ and more research into the “complex relation” between staffing levels and services and safety.

Helen Crump from the Nuffield Trust has examined the evidence around the Secretary of State’s proposals. Crump cites the research from both Freemantle et al and Aylin et al discussed above, while also noting the University of Manchester estimate of an absolute increase of 0.3 per cent for weekend mortality. Furthermore, she stresses that there are “some major questions about the cost”, highlighting that the HFMA estimate of 1.5-2 per cent of trust income “could be enough to push any remaining hospitals just about managing to maintain a surplus into deficit.” The article points to suggestions that the costs of seven-day services would amount to more than £20,000 per quality adjusted life year (QALY) and also contends that there could be “potentially serious consequences across other services” if overall staffing levels are not increased. This prompts Crump to conclude that “pumping more money into the acute sector…goes against the grain of other policies” and that “ramping up weekend elective activity makes no sense if the funding is not available to increase total activity.”

Professor Martin McKee expresses concern about the validity of the Government’s claims that seven-day working could save 6,000 lives annually. He highlights that the previous analysis by Freemantle et al, published in 2012, found that those patients already in hospital “had a significantly reduced risk of dying” on both days of the weekend. Moreover McKee warns of the possibility of “confounding by indication” in relation to the risks faced by those admitted for elective procedures on Sundays and emphasises the “many other possibilities” beyond reduced consultant cover, for example access to community nursing or a delayed decision to admit a frail elderly person. He also cites the figures regarding QALYs for seven-day services, before concluding “it would be useful to have a better understanding of the reasons for any increase in deaths at weekends, details of what is being proposed, and evidence to justify any changes.”

6%

Working child calls to parent on Friday evening or Saturday morning and finds the parent has been seriously ill without the ability to call for help.  The child wondered why they didn't answer the phone.  Ambulance called.

Thank you.  Next.

tough to prove but lots of drinking on a friday night, saturday

and violence related around it

hunt is a politcian and chose numbers to suit his case without checking their veracity.

some time ago i saw a specialist being interviewed on tv whose team does kidney transplants 7 days a week. he said in his unit there is no noticeable difference in mortality rates at the weekend for him and his team but because hunt had put the sh*ts up the public when he offered people operations at the weekend people were reluctant to accept.

mr hunt is well named.