The weekend effect: now you see it, now you don’t

McKee, Martin

doi:10.1136/bmj.i2750

Cited by 32 publications

(26 citation statements)

References 11 publications

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“…It is possible that MTCs are sufficiently well resourced to provide a consistent trauma service and so achieve equivalent outcomes at all hours. An alternative explanation is that the weekend effect is really a coding artefact16 17 that was eliminated by our use of high-quality clinical registry data. Finally, it is possible that the weekend effect identified by previous studies is explained by differences in case mix.…”

Section: Discussionmentioning

confidence: 99%

“…A second possibility is that the weekend effect is an artefact of systematic miscoding in administrative datasets. For example, it has been proposed that the weekend effect can be eliminated by studies that only analyse high-quality data, for example, from clinical registries 16 17. Finally, an alternative explanation is that the delivery of healthcare services varies at the weekend to the detriment of patients.…”

Section: Introductionmentioning

confidence: 99%

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Is there a ‘weekend effect’ in major trauma?

et al. 2016

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BackgroundMany previous studies have shown that patients admitted to hospital at weekends have worse outcomes than those on other days. It has been proposed that parity of clinical services throughout the week could mitigate the ‘weekend effect’. This study aimed to determine whether or not a weekend effect is observed within an all-hours consultant-led major trauma service.MethodsWe undertook an observational cohort study using data submitted by all 22 major trauma centres (MTCs) in England to the Trauma Audit & Research Network. The inclusion criteria were all major trauma patients admitted for at least 3 days, admitted to a high-dependency area, or deceased following arrival at hospital. Patients with Injury Severity Score (ISS) >15 were also analysed separately. The outcome measures were length of stay, in-hospital mortality and Glasgow Outcome Score (GOS). Secondary transfer of patients between hospitals was also included as a process outcome.ResultsThere were 49 070 patients, 22 248 (45.3%) of which had an ISS >15. Within multivariable logistic regression models, odds of secondary transfer into an MTC were higher at night (adjusted OR 2.05, 95% CI 1.93 to 2.19) but not during the day at weekends (1.09, 0.99 to 1.19). Neither admission at night nor at the weekend was associated with increased length of stay, worse GOS or higher odds of in-hospital death. These findings remained stable when confining analyses to the most severely injured patients (ISS >15), excluding transferred patients, and using a single mid-week (Wednesday) baseline.ConclusionsAfter adjustment for known confounders the weekend effect is not detectable within a regionalised major trauma service.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is there a ‘weekend effect’ in major trauma?

et al. 2016

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“…Controversies over the weekend effect have not been limited to the political arena. Some researchers have questioned the existence of the weekend effect,6 while others have highlighted the uncertainty about what causes it 2. Given these persistent controversies and questions, including those generated by the paper by Anselmi et al 7 in this issue, it seems fitting to ask what have we really learnt about the quality and safety of healthcare from 15 years of studies into the weekend effect.…”

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confidence: 99%

What have we learnt after 15 years of research into the ‘weekend effect’?

Bray

Steventon²

2016

BMJ Qual Saf

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“…It's also not clear how Hunt can get back on track with the medical profession after his misrepresentation of evidence to back seven day working. 7 The politics of the strike didn't really go Hunt's way, either. Opinion polls didn't bend away from supporting the doctors, even when faced with full industrial action.…”

Section: Collateral Damagementioning

confidence: 99%