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Dr Foster IntelligenceVariation in hospital services at weekends

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Other papers  Cavallazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of admission to the ICU and mortality: a systematic review and metaanalysis. Chest. 2010;138(1):68–75.

 Marco J, Barba R, Plaza S, Losa JE, Canora J, Zapatero A. Analysis of the mortality of patients admitted to internal medicine wards over the weekend. Am J Med Qual. 2010;25(4):312–318.

 Kuijsten HA, Brinkman S, Meynaar IA, et al. Hospital mortality is associated with ICU admission time. Intensive Care Med. 2010 Jun 15 (E pub ahead of print) PubMed PMID: 20549184.

 Dorn SD, Shah ND, Berg BP, Naessens JM. Effect of weekend hospital admission on gastrointestinal hemorrhage outcomes. Dig Dis Sci. 2010; 55(6):1658–1666.

 James MT, Wald R, Bell CM, et al. Weekend hospital admission, acute kidney injury, and mortality. J Am Soc Nephrol. 2010;21(5):845–851.

 Schilling PL, Campbell DA Jr., Englesbe MJ, Davis MM. A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. Med Care. 2010;48(3):224–232.

 Horwich TB, Hernandez AF, Liang L, et al.Get With Guidelines Steering Committee and Hospitals. Weekend hospital admission and discharge for heart failure: association with quality of care and clinical outcomes. Am Heart J. 2009;158(3):451–458.

 Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol. 2009;7(3):303–310.

 Aujesky D, Jimenez D, Mor MK, Geng M, Fine MJ, Ibrahim SA. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation. 2009;119(7):962–968 .

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Explanations

• Patients• Fewer discharges to alternative place of death• People wait longer before seeking help / admission thresholds raised

• Staff• Fewer• Less experienced• More exhausted

• Available services• Diagnostics• Specialist interventions

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Hospital guide data

• Mortality rates weekend vs weekdays• HSMR• Emergency and Elective HSMR

• Measures of process• Time to operation • Number of discharges• Procedures performed

• Staffing levels• Medical staff on site and on call by grade at weekends and

nights• Nurses and nurse assistants on care of the elderly wards at

weekends and nights

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Staffing data

• Collected by questionnaire distributed to all acute NHS trusts• Communication with assigned trust representative and

confirmed with CEO• Questionnaires distributed in June and completed by

September• Forms filled in online and data returned in printable format

for validation and sign off• Data returned for 190 acute hospitals• 36 were unable to provide data on scheduled staff but could

provide data on actual staff

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Some issues with staffing data

• Staff grade doctors and registrars at non-teaching hospitals • Role of on-call doctors

• Is this a site or trust issue? The role of “satellite” A&E units – e.g. Princess Royal in Sussex – and public understanding of service provision

• Night staffing

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Comments and questions