Weekend effect

In healthcare, the weekend effect is the finding of a difference in mortality rate for patients admitted to hospital for treatment at the weekend compared to those admitted on a weekday. Variations in the outcomes for patients treated for several acute conditions have been studied.

Published research

This figure shows the change in mortality for stroke patients over 30 days in a UK sample as the number of nurses relative to the number of beds in the hospital changes, adjusting for various covariates.

Examples of conditions studied include acute coronary syndrome, myocardial infarction and aortic aneurysm.

Politics

In July 2015 British Health Secretary, Jeremy Hunt, quoted a mortality increase of 15% around weekends. This figure had been used the British Department of Health to propose a "7-day NHS" involving increased staffing at weekend. This figure in fact represented 30-day mortality and the paper used revealed an 8% reduction in mortality rate for patients physically in hospital on a weekend. This reduction in weekend death rate was not publicised by the government.

The weekend effect is an area of particular interest in the National Health Service, and has often been attributed to fewer staff being available during the weekend period. The Royal College of Physicians in 2010 issued a position statement,

"Hospitals undertaking the admission of acutely ill medical patients should have a consultant physician on‐site for at least 12 hours per day, seven days per week, at times related to peak admission periods. The consultant should have no other duties scheduled during this period.

While much of the work of the consultant physician will be on the acute medical unit, provision should be made for a daily consultant visit to all medical wards. In many hospitals this will require input from more than one physician."

Currently emergency treatment, or acute care, is available at all major NHS hospitals at weekends. In most hospitals, sick patients receive care from consultants in "acute" specialties, such as Accident and Emergency, General and Orthopaedic Surgery, Medicine, Anaesthetics, Intensive care, Paediatrics, Obstetrics, Pathology and Radiology. However, most patients are seen at time of diagnosis of an illness and treated, but are not routinely reviewed by any doctor at weekend. In November 2013, the Academy of Royal Medical Colleges set out to address this matter in a document entitled Seven Day Consultant Present Care - Implementation Considerations. Research identified that patients in hospitals fell into 10 key specialties, and discussed the benefit and costs of daily consultant review.

Elective services, or routine care, is rarely carried out at weekends. The provision of seven day elective services has proved divisive between doctors. In 2013, the NHS medical director Bruce Keogh wrote that there is a clinical and compassionate argument for patient convenience. Other doctors state that overall patients are unlikely to benefit, and that limited NHS budget and resources would be better invested in providing emergency care to improve mortality.

In 2015, Health Secretary Jeremy Hunt quoted that the "weekend effect" in the NHS equated to 11,000 excess deaths a year. Doctors are now reporting the Hunt Effect - that some patients, too scared to attend hospital at weekends because of the weekend effect, have become seriously ill or even died as a direct consequence of waiting until Monday before seeking medical advice. Doctors stress that the authors specifically state,

"To assume that [the 11,000 deaths] are avoidable would be rash and misleading."

The paper was widely criticised by clinicians unhappy with the findings, and a comment by a Professor of Cardiovascular Epidemiology wrongly suggested that the report was data-driven rather than based on a prior hypothesis, while in fact the 2015 paper was merely an encore of previous work which analysed an earlier data set in 2012.

In response to this "weekend effect" and the lack of seven day elective services, there have been proposals for major reform to contracts of NHS staff. Staff are in support of strengthening weekend services, but junior doctors have widely criticised these changes as they do not account for the 40% increase in workload and would accelerate the decentralisation of the NHS. The British Medical Association has refused to negotiate until they are given assurances that new contracts safeguard against long working hours, and are fair for female employees and those with families. Junior doctors (any doctor in consultant training) have protested across the country that the changes to NHS staff contracts are not safe and likely to harm patients. In July 2015, UK Consultant doctors were angered by suggestions that the weekend effect is due to consultants who opt out of weekends a figure later shown after FOI request to be less than 0.5%.