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Hospital patients admitted at weekends ‘15% more likely to die’ Hospital patients admitted at weekends ‘15% more likely to die’
(7 days later)
Thousands of patients die every year after being admitted to hospital at the weekend, partly because too few senior doctors are on duty and back-up medical services are not available, dramatic new research shows.Thousands of patients die every year after being admitted to hospital at the weekend, partly because too few senior doctors are on duty and back-up medical services are not available, dramatic new research shows.
About 11,000 more patients a year die within 30 days of going into hospital if they are admitted for treatment between Friday and Monday than do those who arrive on a Tuesday, Wednesday or Thursday.About 11,000 more patients a year die within 30 days of going into hospital if they are admitted for treatment between Friday and Monday than do those who arrive on a Tuesday, Wednesday or Thursday.
The findings have reignited the row over the government’s drive to make the NHS a fully fledged seven-day service days before health secretary Jeremy Hunt’s deadline expires for hospital doctors to accept routine weekend working. He has threatened to force consultants to work if they do not agree to his demand by next Friday.The findings have reignited the row over the government’s drive to make the NHS a fully fledged seven-day service days before health secretary Jeremy Hunt’s deadline expires for hospital doctors to accept routine weekend working. He has threatened to force consultants to work if they do not agree to his demand by next Friday.
An analysis of 14 million patients admitted to hospitals in England in 2013-14 found that those who went in on Sunday were 15% more likely to die than those admitted on Wednesday, while those admitted on Saturday had a 10% higher risk of dying. People admitted at the weekend with cancer, heart problems or after a stroke were at particular risk. They had a “noticeably increased risk of death”, along with cancer patients admitted on Friday or Monday.An analysis of 14 million patients admitted to hospitals in England in 2013-14 found that those who went in on Sunday were 15% more likely to die than those admitted on Wednesday, while those admitted on Saturday had a 10% higher risk of dying. People admitted at the weekend with cancer, heart problems or after a stroke were at particular risk. They had a “noticeably increased risk of death”, along with cancer patients admitted on Friday or Monday.
This latest evidence of substantially increased mortality among patients admitted at weekends will put extra pressure on the British Medical Association, the doctors’ union, to agree to abandon consultants’ existing contractual right to refuse to work at weekends or in the evenings, although the vast majority already do so at least some of the time.This latest evidence of substantially increased mortality among patients admitted at weekends will put extra pressure on the British Medical Association, the doctors’ union, to agree to abandon consultants’ existing contractual right to refuse to work at weekends or in the evenings, although the vast majority already do so at least some of the time.
In a paper published on Sunday by the British Medical Journal, the authors, who include the NHS’s top doctor, Professor Sir Bruce Keogh, say the reasons for the pronounced “weekend effect” include the fact that patients admitted then are sicker and at greater risk of dying than those who start treatment in the week. But they also cite the fact that fewer consultants are present at the weekend and that support services, such as diagnostic testing, “are usually reduced from late Friday through the weekend, leading to disruption on Monday morning”.In a paper published on Sunday by the British Medical Journal, the authors, who include the NHS’s top doctor, Professor Sir Bruce Keogh, say the reasons for the pronounced “weekend effect” include the fact that patients admitted then are sicker and at greater risk of dying than those who start treatment in the week. But they also cite the fact that fewer consultants are present at the weekend and that support services, such as diagnostic testing, “are usually reduced from late Friday through the weekend, leading to disruption on Monday morning”.
“We have shown a clear association between weekend admission and worse patient outcomes. Our analyses show that an increased proportion of higher risk patients are admitted on Saturday and Sunday, when services inside and outside the hospital are reduced,” they say. “There is evidence that junior hospital doctors feel clinically exposed during the weekend and that hospital chief executives are concerned about levels of weekend cover.” They call for urgent changes to the way services are organised and an overhaul of treatments available at weekends. In a scathing indictment of existing weekend arrangements, they add: “Patients generally accept the risks associated with their condition and with any necessary treatment, but they should never have to accept an increased risk because of the way healthcare services are designed and delivered.”“We have shown a clear association between weekend admission and worse patient outcomes. Our analyses show that an increased proportion of higher risk patients are admitted on Saturday and Sunday, when services inside and outside the hospital are reduced,” they say. “There is evidence that junior hospital doctors feel clinically exposed during the weekend and that hospital chief executives are concerned about levels of weekend cover.” They call for urgent changes to the way services are organised and an overhaul of treatments available at weekends. In a scathing indictment of existing weekend arrangements, they add: “Patients generally accept the risks associated with their condition and with any necessary treatment, but they should never have to accept an increased risk because of the way healthcare services are designed and delivered.”
Keogh, NHS England’s medical director, said: “The idea that patients are being harmed because of the way we organise our services is quite simply beyond what any of us can regard as acceptable. The moral and social case for action is simply unassailable.”, said Keogh, NHS England’s medical director. “ I’m not offering people whatever they want, whenever they want it. The priority is to reduce mortality by concentrating on improving the way we design and deliver urgent care for our sickest patients.”Keogh, NHS England’s medical director, said: “The idea that patients are being harmed because of the way we organise our services is quite simply beyond what any of us can regard as acceptable. The moral and social case for action is simply unassailable.”, said Keogh, NHS England’s medical director. “ I’m not offering people whatever they want, whenever they want it. The priority is to reduce mortality by concentrating on improving the way we design and deliver urgent care for our sickest patients.”
Hunt, whose claim in July that a “Monday to Friday” culture was contributing to 6,000 deaths a year led to a furious backlash from doctors, said the study “is a wake-up call, suggesting the ‘weekend effect’ in hospitals may be even more serious than previously thought”.Hunt, whose claim in July that a “Monday to Friday” culture was contributing to 6,000 deaths a year led to a furious backlash from doctors, said the study “is a wake-up call, suggesting the ‘weekend effect’ in hospitals may be even more serious than previously thought”.
Key medical bodies, including those  representing hospital doctors and surgeons, said the findings underlined the need to move to a seven-day NHS in order to improve care at weekends and save lives.  Key medical bodies, including those representing hospital doctors and surgeons, said the findings underlined the need to move to a seven-day NHS in order to improve care at weekends and save lives.
The Royal College of Surgeons said that “in many hospitals, the levels of staffing and access to diagnostics are worse for all patients, including those requiring emergency treatment over the weekend”. It is not just down to the fact that those admitted on Saturday and Sunday are often sicker, said Claire Marx, its president.The Royal College of Surgeons said that “in many hospitals, the levels of staffing and access to diagnostics are worse for all patients, including those requiring emergency treatment over the weekend”. It is not just down to the fact that those admitted on Saturday and Sunday are often sicker, said Claire Marx, its president.
For example, just 41% of patients needing life-or-death emergency bowel surgery after midnight had both a consultant surgeon and a consultant anaesthetist present at their operation, Marx added.  For example, just 41% of patients needing life-or-death emergency bowel surgery after midnight had both a consultant surgeon and a consultant anaesthetist present at their operation, Marx added.
Professor Dame Sue Bailey, chair of the Academy of Medical Royal Colleges, which represents the UK’s 250,000 doctors, said: “The BMJ’s findings underscore what has been known, but seemingly ignored, for too long.” Enough staff of sufficient seniority must be available in hospitals at weekends as well as weekdays, though “this does not mean seven-day working for staff”, but the NHS would need more money in order to ensure that happened, she added.Professor Dame Sue Bailey, chair of the Academy of Medical Royal Colleges, which represents the UK’s 250,000 doctors, said: “The BMJ’s findings underscore what has been known, but seemingly ignored, for too long.” Enough staff of sufficient seniority must be available in hospitals at weekends as well as weekdays, though “this does not mean seven-day working for staff”, but the NHS would need more money in order to ensure that happened, she added.
However, Professor Jane Dacre, president of the Royal College of Physicians, stressed that increased deaths among patients admitted on Saturday and Sunday “are unlikely to be just due to the numbers of doctors working at weekends. There is new evidence that not all excess deaths at weekends are avoidable.”However, Professor Jane Dacre, president of the Royal College of Physicians, stressed that increased deaths among patients admitted on Saturday and Sunday “are unlikely to be just due to the numbers of doctors working at weekends. There is new evidence that not all excess deaths at weekends are avoidable.”
The BMA said doctors want the care they provide to be of the same standard across the week. Money needs to be put into improving access to urgent and emergency care at weekends to ensure that patients receive the best care at all times, said Dr Mark Porter, its council chair. “Nine in ten consultants already work around the clock delivering this care but additional services will require not just more doctors, but extra nurses, diagnostic and support staff.”The BMA said doctors want the care they provide to be of the same standard across the week. Money needs to be put into improving access to urgent and emergency care at weekends to ensure that patients receive the best care at all times, said Dr Mark Porter, its council chair. “Nine in ten consultants already work around the clock delivering this care but additional services will require not just more doctors, but extra nurses, diagnostic and support staff.”
The BMA warned that if more consultants worked at weekends, care in the week would inevitably be reduced.The BMA warned that if more consultants worked at weekends, care in the week would inevitably be reduced.