Are hospital patients more likely to die if admitted on weekends?
11th Oct 2012
This article has been updated. See below.
According to the reports, the sparcity of medical consultants on duty on Saturday and Sunday was the reason for the increased risk.
But, you may ask, how much more likely to die are they? And that's where it gets tricky.
According to the Telegraph, "the chance of dying in hospital is between 10 and 14 per cent higher if admitted as an emergency at the weekend than during the week." In the Daily Mail it is reported that "patients are up to 16 per cent more likely to die if they are admitted at the weekend."
The Sun however was in a league of its own claiming that the risk was inflated by a much larger margin:
According to the red top, patients unfortunate enough to need hospital care during weekends are twice as likely to shuffle off this mortal coil than those checking in during the working week. Where are these figures from? And who is right?
The story was based on a report published yesterday by the Royal College of Physicians (RCP) in conjuction with the Society for Acute Medicine, which in itself does not contain precise figures on the supposed increase in mortality rates for weekend admissions.
A spokesperson for the RCP said that "although the toolkit and press statement referred to the evidence that patients admitted to hospital at weekends are more likely to die than those admitted on weekdays, neither contained any specific statistics. The toolkit references four published papers for this evidence."
Here are the four papers quoted in the report:
- Weekend hospitalization and additional risk of death; Journal of the Royal Society of Medicine (2012): reports an 11% increase in risk on Saturdays and a 16% increase for Sunday.
- Higher senior staffing levels at weekends and reduced mortality. British Medical Journal (2012): Study based on 2011 findings that mortality is 10% higher in patients admitted to acute hospitals at the weekend than during the week.
- Mortality among patient admitted to hospitals on weekends compared with weekdays. New England Journal of Medicine (2001) carried out in Ontario, Canada, found a 1.8% increase in mortality among patients admitted on a weekend.
- The impact of weekends on outcome for emergency patients. Clinical Medical (2005): This study concluded that overall mortality was increased for admissions on Mondays.
The above studies were carried out in different time periods (some from over a decade ago) and in some cases in different countries, or had even offered different conclusions from the ones found on today's newspapers.
However from this it is possible to see where the Mail has obtained its figure, taking the Sunday figure from the first study. The Telegraph seems to be referencing a slightly different figure which focuses on emergency admissions, but is in a similar ballpark to the Mail.
The Sun's figure doesn't seem to appear in any of the literature, and its genesis is even less clear. We've got in touch with the paper to ask for some clarity or a correction, and will update as soon as we hear back.
More up-to-date and UK-centric insights into mortality rates at NHS hospitals and what is known as "the weekend effect" have been provided by a British Medical Journal research paper. Unlike the above studies, however, these relate strictly to non-emergency operations in England, rather than overall mortality rates following hospital admissions.
The study found that people who undergo what is known as an "elective operating room procedure" on Friday are 44% more likely to die than those who have their operation on Monday. The risk was higher still for surgeries carried out at the weekend: 82% greater than on a Monday.
The researchers looked at over 4 million inpatient admissions for non-emergency surgeries at NHS hospitals from 2008/09 to 2010/11. Out of these, 27,582 patients died within 30 days of surgery for an overall mortality rate of 0.67%.
The researchers urged caution with the figures, given that only a minority of operations currently take place on weekends.
Flickr image courtesy of ro_buk