Researchers say higher than expected mortality rates may be linked to a decrease in the availability of senior hospital staff at the weekend - <em>News Release</em>

Imperial College London News Release

For Immediate Release
Friday 11 June 2010

People admitted to English hospitals in an emergency at the weekend have, on average, a seven percent higher mortality rate than people admitted between Monday and Friday, according to research published in the journal Quality & Safety in Health Care this week.

The new study is the largest ever to look at the differences between weekend and weekday mortality, focusing on the deaths of patients admitted as emergencies to 163 acute hospital trusts in England during 2005/06.

The study's authors, from the Dr Foster Unit and the Department of Acute Medicine at Imperial College London, say the higher than expected mortality rates they identified during the period may be linked to less consistent specialist services such as diagnostics at weekends and a decrease in the availability of senior hospital staff. However, the authors say more research is needed before they can draw any firm conclusions about the causes of the apparent increase in mortality rates.

In particular, the research shows a higher mortality rate at the weekend compared to weekdays for patients with conditions including heart attack, heart failure, stroke, some cancers and aortic aneurysms.

The authors suggest poorer access to hospital services and variations in staffing levels at the weekend may be contributing to the difference in death rates. In addition, specialist community and primary care services such as those for cancer patients may operate a reduced service at the weekends, which the authors say could result in some terminally ill patients dying in hospital at the weekends rather than at home.

In the study, which was supported by Dr Foster Intelligence, the researchers reviewed 215,054 deaths out of a total of 4,317,866 admissions.

The researchers reviewed 215,054 deaths out of a total of 4,317,866 emergency admissions in 2005/06

They found that overall death rates were 5.2% for people admitted at weekends and 4.9% for those admitted on a weekday in 2005/6. After taking into account factors such as age, sex, socio-economic deprivation, diagnosis and co-morbidities they calculated that the death rate for people admitted at the weekend was around 7% higher than the weekday death rate. Comparing the expected number of deaths with the actual number of deaths identified at the weekend the researchers found there were 3,369 more deaths than expected occurring at the weekend in 2005/06.

Dr Paul Aylin, the senior author of the study from the Dr Foster Unit at Imperial College London, said: "We estimate that there were over 3,000 more deaths than expected at weekends in 2005/06 compared to weekdays - more than the number of people dying in road accidents in 2006. Clearly this is a significant number of people and we need to get to the bottom of what this means.

"Staffing levels are often lower at weekends, with fewer senior medical staff around, and some specialist services are less available. We believe this may be contributing to the increase in mortality rates on Saturdays and Sundays but we would like to see more research.

"Hospitals have been reassessing the working hours and rotas of their doctors and, considering the impact that staff availability may be having on mortality rates, this is a timely reminder to hospitals that they must take care not to jeopardise the quality and standard of patient care available at weekends when devising new staffing rotas," added Dr Aylin.

Professor Derek Bell, one of the authors of the paper from the Department of Medicine at Imperial College London, added: "Clinicians and senior healthcare managers must begin to recognise and address these issues to improve patient care."

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Lucy Goodchild
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Imperial College London
E-mail: lucy.goodchild@imperial.ac.uk
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Notes to Editors:

1. "Weekend mortality for emergency admissions. A large, multicentre study" Quality & Safety in Health Care, Wednesday 9 June 2010, doi:10.1136/qshc.2008.028639
Corresponding author: Dr Paul Aylin, Imperial College London
(For full list of authors please see paper)

2. Dr Foster Intelligence is the UK's market-leading provider of information, analysis and targeted communications to health and social care organisations. An independent organisation, Dr Foster Intelligence was launched in 2006 as a joint venture between Dr Foster Holdings LLP and the NHS Information Centre for health and social care.

Dr Foster Intelligence aims to set a new standard in information for health and social care providers and their users and is legally required to follow a code of conduct that prohibits political bias and requires it to act in the public interest.
For more information, please visit www.drfoster.co.uk.

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Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.

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