“Weekend effect” is not reduced by clinical standards designed to tackle it, study finds

Authors: Abi Rimmer 

Publication date:  09 Nov 2017


Clinical standards designed to reduce mortality at the weekend have not made any overall difference, researchers have found.

In a paper published in the Emergency Medicine Journal, researchers from the University of Manchester said that four NHS priority standards for emergency care have not reduced excess deaths on Saturdays and Sundays.[1]

The four standards were originally developed in 2013 by the NHS Services, Seven Days a Week Forum. They were introduced in 2015 and form part of the government’s aim to reduce the “weekend effect”—when patients admitted to hospital at a weekend have greater mortality than patients admitted on weekdays—through increased seven day working.

The four priority standards measure the time to first consultant review, access to diagnostics, access to consultant directed interventions, and ongoing consultant review. By 2020, compliance will be mandatory for all hospitals in England, with financial penalties for those that do not meet them.

The researchers looked at data on the performance of 123 trusts against the standards in the summer of 2015 and compared them with figures on mortality within 30 days of admission in 2015-16.

They found that, while trusts that had met two of the standards (ongoing review and access to diagnostic services) had experienced a very small reduction in weekend mortality, overall the standards had made no difference to weekend deaths.

“We found no association between trusts’ performances against any of the four standards and the current magnitude of their weekend effects, or the change in their weekend effects over the past three years,” the researchers said.

One potential reason they gave for the lack of a relation between trusts achieving the standards and weekend deaths was that “standards themselves are not effective in reducing mortality.”

They added, “Given the absence of evidence supporting a causal link between the standards and mortality, this would not be unexpected. While it is unlikely that offering this standard of care to all patients would result in any direct harm, doing so diverts resources and attention away from other potential care provision and therefore has an opportunity cost.”

The researchers called for publication of statistics that track the progress of the government’s seven day services policy and the impact it has had on patient outcomes. “Implementing seven day services has been estimated to cost £1.07bn-£1.43bn, most of which relates to recruitment of additional medical staff, yet there is currently no evidence that this initiative has resulted in any patient benefit,” they said.

Compulsory compliance with the four standards, they concluded, may not be “the best way to allocate scarce NHS resources or increase overall quality of care provided.”

Commenting on the study, Amitava Banerjee, senior clinical lecturer in clinical data science and honorary consultant cardiologist at University College London, said, “Before these standards become mandatory in 2020, they should be reviewed and should not be prioritised. Evidence based policy is especially important in times of austerity, when pressures on both human and financial resources make targets even harder to meet.

“Resources should not be wasted on targets which do not change quality of care or patient outcomes.”

References

  1. Meacock R, Sutton M. Elevated mortality among weekend hospital admissions is not associated with adoption of seven day clinical standards. Emerg Med J  2017;0:1-6. [Link] .

Abi Rimmer The BMJ

 arimmer@bmj.com

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