It is 20 years since researchers discovered that patients admitted to hospitals on Saturdays or Sundays are more likely to die than those admitted Monday to Friday. The ‘weekend effect’ was assumed to be because fewer hospital specialists work at weekends, meaning care was less good. However, there was no evidence to support this assumption.
This NIHR Alert is based on: This NIHR Alert is based on: Bion J, and others. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. Health Services and Delivery Research 2021;9:13.
People admitted to hospitals on Saturday or Sunday are more likely to die than those admitted Monday to Friday. This is the so-called ‘weekend effect’. It has been assumed that extra deaths occur because fewer hospital consultants are present at weekends than during the week.
New research from Bion et al. challenges this assumption. It shows that people admitted as emergencies at weekends are sicker and more likely to be near the end of life than those who come in during the week. A large 5-year study found hospital care at the weekend is, if anything, better than weekday care. However, markers of community care were worse at weekends than on weekdays.
The study found that the numbers of consultants did not account for the weekend effect. There was no evidence that errors in hospital care were more common at weekends. Over the course of the study, consultants worked increasing hours in hospital at the weekends caring for emergency admissions. But this increase in their hours was overtaken by the increase in the numbers of people admitted at the weekends.
The weekend effect is likely to be a result of insufficient care in community settings at the weekend, the researchers say. This could mean, for example, that people nearing the end of life, who would be better cared for at home, end up in hospital because community services are not available.
Using an expert panel, and computer modelling, the study found that investing in more consultant hours at the weekend could be cost-efficient. But this was only because it might speed up discharge decisions rather than reducing death rates. However, there was also evidence that earlier discharge may be associated with transferring hospital deaths into the community.
The study concluded that the best way to bring weekend care up to weekday levels would be to invest in community services.