Hospital patients admitted on weekends 'have a higher risk of death'

A recent study, published in The British Medical Journal (BMJ), found that patients admitted to hospital at the weekend are more likely to be sick and have a higher risk of death, compared with those admitted during the week.

Researchers have called on the Government to take action as people are 15 per cent more likely to die if admitted to hospital on a weekend day, compared to a week day.

Health Secretary, Jeremy Hunt, said: “Around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals.

"Patients are 15 per cent more likely to die if they are admitted on a Sunday compared to being admitted on a Wednesday. No one could possibly say that this was a system built around the needs of patients.”

Mr Hunt previously pledged a seven-day working service on hospital doctors in England to reduce the number of patient deaths and to improve quality of care.

The pledge will see patients receive the same high quality, safe level of care on a Saturday and Sunday as they do on a weekday. This means having enough consultants available to assess and review patients, providing access to important diagnostic tests and ensuring that consultants are available to make crucial clinical judgements.

It comes after various studies have revealed that hospital patients currently receive poorer healthcare services at weekends, with individuals more likely to die on a Saturday or Sunday, rather than on a weekday.

A BMJ study examined the effect of hospital admission day on death rates across National Health Service (NHS) England hospitals for 2013-2014.

11,000 people die each year within 30 days of hospital admission

Findings from the study revealed that approximately 11,000 people die each year within 30 days of admission to hospital on Friday, Saturday, Sunday, or Monday compared with other days of the week (Tuesday, Wednesday, Thursday).

Researchers of the study have suggested that this ‘weekend effect' could be partly explained by a lack of consultant cover and reduced support services that start from late Friday through the weekend, leading to disruption on Monday morning.

Furthermore, it has been suggested that people with a greater severity of illness may be admitted at weekends because of a lack of services in the community for those at the end of life.

The study also looked at patient characteristics, length of hospital stay, and time between admission and death.

An average of 2.7 million patients were admitted to hospital on each weekday, while an average of 1.2 million patients were admitted on a Saturday and 1 million patients admitted on a Sunday.

Saturday and Sunday admissions were more likely to be emergencies, 50 per cent and 65 per cent respectively, than on weekdays with 29 per cent. Length of stay was also higher for patients admitted on a Saturday and Sunday.

In addition, a higher proportion of patients admitted on the weekend were identified to have diagnoses that placed them in the highest risk of death category, with almost 30 per cent compared with less than 20 per cent of weekday admissions.

Mr Hunt has urged that contracts for new consultants need to be modernised to ensure NHS patients do not have to worry about a lack of senior clinical presence if they are admitted to hospital on a Saturday or Sunday.

The current consultant contract means senior doctors can opt out of weekend work as long as it is non-emergency in nature – although they are still expected to be on call.

'Seven-day working will cost significant amounts of money'

However, Nigel Edwards, chief executive of Nuffield Trust has raised concern over a lack of specialist trained staff available in hospitals at the weekend. He said: “The truth is there is more than one reason for the longstanding problem of patchy weekend services. These proposals assume that the biggest obstacle to seven-day working is that consultants are unwilling to work at weekends.

“While more hospital doctors working on Saturdays and Sundays could help in some areas, other staff – from those trained in scanning and imaging to lab technicians and pharmacists – are just as crucial. Without this, we risk having hospitals full of consultants, but without the scans or tests patients need for the doctors to take action.”

Mr Edwards continued: "Perhaps the biggest barrier to seven-day working is finding the money to pay for it. The £8bn pledged by the Government for the NHS by 2020 is only just enough to keep up with population change.

“Estimates suggest that seven-day working will cost significant amounts of money, but it is still unclear where this will come from at a time when the NHS needs to find huge and unprecedented efficiency savings. A genuine seven-day service will also inevitably mean tough decisions about merging or closing much-loved local wards.

Helen Crump, fellow in health policy at the Nuffield Trust, added: “It is not clear how or to what extent investment in seven day services will reduce weekend deaths, and the costs may outweigh any benefits.

“Unless overall staffing levels increase, ramping up services at the weekend will leave a gap in the hospital’s weekday rota, with potentially serious consequences across other services.”