Two new studies negate link between risk for death and weekend staffing

Two new studies negate link between risk for death and weekend staffing

Two new studies from the UK published online May 10, 2016 in the Lancet have found no link between weekend staffing levels in hospitals to mortality.  These results are in contradiction to earlier studies, which had supported the so-called weekend effect i.e. patients admitted to hospital over the weekend are at an increased risk of death. In 2001, a study published in the New England Journal of Medicine was the first to show that patients with some serious medical conditions are more likely to die in the hospital if they are admitted on a weekend than if they are admitted on a weekday.

• In the study on acute stroke care, researchers from the Farr Institute of Health Informatics Research at the University College London in the United Kingdom and colleagues say that the weekend effect is a simplification, and just one of several patterns of weekly variation occurring in the quality of stroke care. Four patterns of variation were identified: a diurnal pattern (thrombolysis, brain scan within 12 h, brain scan within 1 h, dysphagia screening), a day of the week pattern (stroke physician assessment, nurse assessment, physiotherapy, occupational therapy, and assessment of communication and swallowing by a sleep and language therapist), an off-hours pattern (door-to-needle time for thrombolysis) and a flow pattern whereby quality changed sequentially across days (stroke-unit admission within 4 h). One quality measure, door-to-needle time within 60 minutes, had a particularly strong link to day of week and time of day, and it was worse over nights and on weekends. This pattern could be due to loss of spare bed capacity over the weekend.

• In the second cross-sectional study from the University of Birmingham in the United Kingdom, researchers did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions, but found a substantial difference between weekend and weekday specialist involvement in caring for patients admitted as emergencies to acute hospitals in England. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40–58) of that on Wednesday.