Emergency medical patients admitted at weekends have worse clinical outcomes than those admitted during the working week.
For instance, the first graph shows the standardised mortality rate by day of week for emergency medical patients. At weekends, the mortality rate is significantly higher than average. A similar analysis shows that patients admitted at the weekend are more likely to need to be readmitted to hospital after their discharge.
There are a number of reasons for this. Perhaps patients admitted at the weekend are in some way different from patients admitted during the week and this difference is not accounted for in our standardisation model. An alternative explanation is that there are fewer senior clinical decision makers and poor access to diagnostic services available at the weekend.
Last year’s Royal College of Physicians report Acute Medical Care recommended that there should be 24/7 urgent access to lifesaving interventions such as gastro-intestinal endoscopies. And in a recent data briefing, attention was drawn to variation by day of week for emergency surgical procedures.
The second graph shows that fewer patients who required gastro-intestinal endoscopies received them on the day of admission during the weekend. This suggests that access to gastro-intestinal endoscopies is reduced at the weekend.
Weekend discharges
The final graph shows the rate of discharges by day of week. A similar pattern emerges where fewer patients are discharged on Saturday or Sunday, the majority being discharged on Friday. This could be due to consultant unavailability at weekends in order to sign off the discharge. Observing this over time does not appear to show a difference: this is a consistent pattern. Given that many hospitals are under severe pressure to find beds, lack of discharges over the weekend is indicative of a lack of senior clinical decision makers available over the weekend.
The NHS is a 24/7 service and emergency medical care must reflect this. It is imperative that patients receive high quality care whichever day they are admitted and do not experience delays to their treatment due to unavailability of key clinical decision makers. Trusts need to review hospital admissions data in this way in order to investigate the reasons behind these apparent delays and poor outcomes to patient care at the weekend so this variation can be reduced.
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