About the study
The rationale for HiSLAC (High-intensity Specialist-Led Acute Care) is based on research in diverse health systems demonstrating poorer outcomes for patients admitted to hospitals at weekends. In the UK, four recent initiatives to address this problem include the Academy of Medical Royal College's publications 'Benefits of Specialist-Delivered Care' and the Academy's standards document 'Seven Day Specialist-Present Care'; the Royal College of Physicians Future Hospital Commission to examine new ways of providing specialist care; and the NHS Services Seven Days a Week Forum's Summary of Initial Findings which led to the setting out of an implementation timetable for 7-day services in Everyone Counts: Planning for Patients 2014/15 to 2018/19. Changing long-established working patterns is challenging. The study will combine quantitative analysis with qualitative (ethnographic) research to measure quality of care and to explore cultural and behavioural aspects of a fundamental change in service delivery. We will also conduct a health economic assessment of improving specialist cover over week-ends to review the cost-effectiveness and the budget impact of HiSLAC.
In Phase 1 we developed the metrics to measure the intensity of specialist-led care and mapped levels of 'penetration' of high-intensity care nationally. Measurements will be made annually until 2018 to track changes in specialist intensity with patient outcome data using the model of a natural experiment.
In conjunction with the national analysis, in Phase 2 of the project (2015-2018), we are undertaking a detailed quantitative and qualitative analysis of 10 HiSLAC and 10 low-intensity (LoSLAC) case study hospitals. In this three-pronged case study we will use local patient administration data to supplement routine data from HES, undertake case note review to examine quality of care, and perform on-site ethnographic exploration to investigate how systems of care operate weekends and weekdays and the barriers and facilitators to implementation of seven-day-services.
In addition to the above analyses we are also carrying out two linked systematic reviews of relevant literature to investigate the magnitude and mechanisms of the weekend effect in hospital admissions, as well as a sub-study using physiological data to examine whether patients admitted at weekends are 'sicker' than patients admitted during the week.