Monday, 22 October 2012

Lost Weekend

Do not get ill at the weekend.

New research adds to concerns about consultant cover in the NHS at weekends.

The research was published in the Royal Society of Medicine Journal and showed that weekend hospitalisation was associated with signficantly higher death rates, Dr Andrew Goddard, Royal College of Physicians director of medical workforce, said:

‘This study is further evidence that patients admitted at weekends are more likely to die following admission than patients admitted to hospital during the week. There are many reasons for this, but the two most important are that the patients are more ill and there are fewer doctors available.

‘The Royal College of Physicians has already called for any hospital admitting acutely ill patients to have a consultant physician on-site for at least 12 hours per day, seven days a week.’
It seems that mortality rates are at least 10% higher in NHS hospitals for patients admitted at weekends.

Purely anecdotally (from my own practice) it is clear that there are higher mortality rates at weekends. Moreover, the problem may be understated, because poor service at weekends may affect mortality even for some patients admitted on weekdays. A patient admitted on a Friday night with an acute abdomen may have the most urgent need for adequate care in the early hours of the following Sunday.

Further, from my experience of negligence cases, I would not be surprised if the morbidity rate was also significantly higher both at weekends and as a result of poor weekend cover.

Medical experts in conference often tell me that the standard of service at weekends is not as good as on weekdays. It seems that investigations are not always available and - this is purely my impression - junior staff are reluctant to call out more senior colleagues to see patients.

I am not an NHS manager, but surely one way of reducing the compensation bill for the NHS, and more importantly to protect patients, would be to manage the service on the basis that patients are likely to need the same level of service whenever they come into a hospital.

It would be very interesting to see figures from the NHSLA of what proportion of claims arise from allegations of negligence at weekends. I would expect it to be higher than 2/7ths!

It is no defence to a claim for damages that the acts and omissions claimed to have been negligent were on a Saturday or Sunday. There might in some cases in which a Defendant Trust might argue that as a result of resource restrictions it was not possible to offer the same level of service at a weekend as on a weekday, but if that is so, then the public has a right to know that that is the position.

Afterword:
Following initial publication of this blog it was pointed out to me by twitter that the nature of patient admissions at weekends might increase mortality. It may of course be true that there are far more admissions following heavy drinking or fights at weekends. That may skew the mortality figures upwards. I wonder if also some patients wait until the weekend to go to hospital because they do not want to take time off work, or have to be around for the children during weekdays. But these factors, if they are explanations of higher mortality following weekend admission, would surely mandate even more resources and consultant cover for weekends rather than less.

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