Weekend effect: complex metric for a complex pathway

Published: 02 January 2020
Author(s) Julian Bion

  • In this editorial, HiSLAC Principal Investigator, Prof Julian Bion, comments on a study (see link below) examining the relationship between off-hours admissions for primary percutaneous coronary intervention, door-to-balloon time and mortality for patients with ST-elevation myocardial infarction.

    In the article Julian comments: “The search for the cause of the weekend effect clearly needs to include community services, but Jayawardana and colleagues provide a timely reminder that it is the whole patient pathway which is of interest, not just isolated segments.”

    BMJ Quality & Safety Editorial

    The relationship between off-hours admissions for primary percutaneous coronary intervention, door-to-balloon time and mortality for patients with ST-elevation myocardial infarction in England: a registry-based prospective national cohort study


Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis

Published: 05 June 2019
Author(s) Yen-Fu Chen, Xavier Armoiry, Caroline Higenbottam, Nicholas Cowley, Rajna Basra, Samuel Ian Watson, Carolyn Tarrant, Amunpreet Boyal, Elizabeth Sutton, Chia-Wei Wu, Cassie P Aldridge, Amy Gosling, Richard Lilford, Julian Bion

  • In this largest review of the scientific literature on the ‘weekend effect’ to date researchers Warwick examined 68 studies covering data from over 640 million hospital admissions across the world and concluded that, contrary to commonly held assumptions, the higher death rates amongst patients admitted to hospital at weekends are unlikely to reflect in-hospital quality of care, and may be attributed to differential criteria for admitting patients and other factors in the community preceding hospital admission.

    BMJ Open

Quality and safety of in-hospital care for acute medical patients at weekends: a qualitative study

Published: 10 January 2019
Author(s) Elizabeth Sutton, Julian Bion, Cassie Aldridge, Amunpreet Boyal, Janet Willars and Carolyn Tarrant

  • The increased mortality risk associated with weekend admission to hospital (the 'weekend effect') has been reported across many health systems. More recently research has focused on causal mechanisms. Variations in the organisation and delivery of in-hospital care between weekends and weekdays have been identified, but this is not always to the detriment of weekend admissions, and the impact on mortality is uncertain. The insights of frontline staff and patients have been neglected. This article reports a qualitative study of patients and clinicians, to explore their views on quality and safety of care at weekends.

Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust

Published: 10 October 2018
Author(s) Jianxia Sun, Alan J Girling, Cassie Aldridge, Felicity Evison, Chris Beet, Amunpreet Boyal,Gavin Rudge, Richard J Lilford, Julian Bion

  • This objective of this study was to determine whether the higher weekend admission mortality risk is attributable to increased severity of illness.In conclusion, we found that patients admitted to hospital on weekends are sicker than those admitted on weekdays. Evidence suggests that cause of the weekend effect may lie in community services.

Protocol for the health economic evaluation of increasing the weekend specialist to patient ratio in hospitals in England

Published: 17 April 2018
Author(s) Samuel Watson, Yen-Fu Chen, Julian Bion, Cassie Aldridge, Alan Girling, Richard Lilford, HiSLAC Collaboration

  • This protocol concerns the evaluation of increased specialist staffing at weekends in hospitals in England. Seven-day health services are a key policy for the UK government and other health systems trying to improve use of infrastructure and resources. A particular motivation for the 7-day policy has been the observed increase in the risk of death associated with weekend admission, which has been attributed to fewer hospital specialists being available at weekends. However, the causes of the weekend effect have not been adequately characterised; many of the excess deaths associated with the ‘weekend effect’ may not be preventable, and the presumed benefits of improved specialist cover might be offset by the cost of implementation.

Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays

Published: 08 January 2018
Author(s) Bion J, Aldridge C, Girling A, Rudge G, Beet C, HiSLAC Collaboration

  • The mortality associated with weekend admission to hospital (the ‘weekend effect’) has for many years been attributed to deficiencies in quality of hospital care, often assumed to be due to suboptimal senior medical staffing at weekends. This protocol describes a case note review to determine whether there are differences in care quality for emergency admissions (EAs) to hospital at weekends compared with weekdays, and whether the difference has reduced over time as health policies have changed to promote 7-day services.

A protocol for a team-based ethnography of weekend care for medical patients in acute hospital settings

Published: 15 March 2017
Author(s) Tarrant C, Sutton E, Angell E, Aldridge C, Boyal A, Bion J, HiSLAC Collaboration

  • It is now well-recognised that patients admitted to hospital at weekends are at higher risk of death than those admitted during weekdays. However, the cause(s) of this ‘weekend effect’ are poorly understood. Some contend that there is a deficit of medical staff at weekends resulting in poorer quality care, while others find that patients admitted to hospital at weekends are sicker and therefore at higher risk of adverse outcomes. Clarifying the causal pathway is clearly important in order to identify effective solutions. In this article we describe an ethnographic approach to evaluating the organisation and delivery of medical care at weekends compared with weekdays, with a specific focus on the role of medical staff as part of NHS England’s plan to implement seven-day services.

The magnitude and mechanisms of the weekend effect in hospital admissions: A protocol for a mixed methods review incorporating a systematic review and framework synthesis

Published: 23 May 2016
Author(s) Chen, Boyal et al; HiSLAC Collaboration

  • Growing literature has demonstrated that patients admitted to hospital during weekends tend to have less favourable outcomes, including increased mortality, compared with similar patients admitted during weekdays. Major policy interventions such as the 7-day services programme in the UK NHS have been initiated to reduce this weekend effect, although the mechanisms behind the effect are unclear. Here, we propose a mixed methods review to systematically examine the literature surrounding the magnitude and mechanisms of the weekend effect.

Weekend specialist intensity and admission mortality in acute hospital Trusts in England: a cross-sectional study

Published: 11 May 2016
Author(s) Aldridge, Bion et al; HiSLAC Collaboration

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HiSLAC PI Prof Julian Bion features in this month's @TheDrMagazine in his role as Freedom to Speak up Guardian……


"The search for the cause of the #weekendeffect clearly needs to include community is the whole patie……


Read HiSLAC PI, Prof Julian Bion's editorial, "Weekend effect: complex metric for a complex pathway"……


Merry Christmas from all the HiSLAC team!

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