I picked up on news today that patients are more likely to die if they are admitted on a weekend compared to a weekday. This has come after a study was carried out in "the Journal of the Royal Society of Medicine" (http://www.bbc.co.uk/news/health-16868428).
Let's look at the stats (all from http://www.bbc.co.uk/news/health-16868428);
1. Research was carried out by UCL (University College London), UEA (University of East Anglia) and Birmingham University.
2. It covered more than 14 million hospital admissions and 187,300 patients who died within 30 days of being admitted (during 2009/2010).
3. For every 100 deaths on a Wednesday there were 116 on a Sunday.
4. The results were consistent with data from 254 not-for-profit hospitals in the United States, which they also analysed.
So the obvious issue here is that more patients are dying on the weekend than in the weekday. This is maybe because of the lack of senior medical staff/consultants working on the weekend; as suggested by Professor Domenico Pagano on the BBC website. The lack of senior staff could have a major impact because of the experience that they offer in emergency situations; experience that can only come with time for junior doctors.
Another issue is what action to take now that this study has been carried out. What really needs to happen is that there needs to be more experienced doctors in the hospitals or close enough to the hospitals to be there in an emergency rather than on call (not very practical though). If there are more consultants consistently in the hospitals over the whole week, then the death rate should theoretically be lowered, based on the idea that experienced staff around means less deaths (but not no deaths).
It would be interesting to get some statistics on the mortality rates against the number of consultants and junior doctors working on the wards to see if there is a correlation between mortality rate and the experience of the staff on duty.
Let's look at the stats (all from http://www.bbc.co.uk/news/health-16868428);
1. Research was carried out by UCL (University College London), UEA (University of East Anglia) and Birmingham University.
2. It covered more than 14 million hospital admissions and 187,300 patients who died within 30 days of being admitted (during 2009/2010).
3. For every 100 deaths on a Wednesday there were 116 on a Sunday.
4. The results were consistent with data from 254 not-for-profit hospitals in the United States, which they also analysed.
So the obvious issue here is that more patients are dying on the weekend than in the weekday. This is maybe because of the lack of senior medical staff/consultants working on the weekend; as suggested by Professor Domenico Pagano on the BBC website. The lack of senior staff could have a major impact because of the experience that they offer in emergency situations; experience that can only come with time for junior doctors.
Another issue is what action to take now that this study has been carried out. What really needs to happen is that there needs to be more experienced doctors in the hospitals or close enough to the hospitals to be there in an emergency rather than on call (not very practical though). If there are more consultants consistently in the hospitals over the whole week, then the death rate should theoretically be lowered, based on the idea that experienced staff around means less deaths (but not no deaths).
It would be interesting to get some statistics on the mortality rates against the number of consultants and junior doctors working on the wards to see if there is a correlation between mortality rate and the experience of the staff on duty.
Have you considered that people admitted at the weekend are more likely to be seriously ill as there are no routine operations at the weekend, so all operations performed are emergency ones in which the risk of complication is higher. Doctors on call at the weekend are a maximum of half an hour away, and will be informed if there anyone is going into theater, and if there is a likelihood of complications needing their expertise.
ReplyDeleteBen. The stats make worrying reading. The other (long recognised) worry is when junior doctors change jobs (Traditionally February/August - although now every 4 months). Anonymous makes a good statistical point here. Admissions (And bed occupation) during the week will tend to be skewed towards fitter patients who attend for routine and non life threatening surgery. Remember surgeons tend to only operate on people who are pre-screened and likely to survive an operation! Over the weekend, the vast majority of admissions will be emergency referrals to the physicians (As opposed to surgeons). These patients tend to be older and very ill, so are more likely to die. Should hospital consultants all be resident in hospital on call? That could prove costly! Everyone needs time off work, and it has traditionally always been at weekends for consultants. Has the time come when consultants need to stop having weekends off? Should shifts with variable days off be
ReplyDeleteintroduced? What are the financial implications of having very expensive staff (Consultants) formally working nights and weekends (On call costs the NHS less). European working time directives have to be met. Would there be a recruitment crisis into hospital medicine if that were the case? Ishigawa
I like coming back to your blog and reading it every now and then. Keep it coming
ReplyDelete