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

Abstract

IntroductionThe 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.Methods and analysisCross-sectional two-epoch case record review of 20 acute hospital Trusts in England. Anonymised case records of 4000 EAs to hospital, 2000 at weekends and 2000 on weekdays, covering two epochs (financial years 2012–2013 and 2016–2017). Admissions will be randomly selected across the whole of each epoch from Trust electronic patient records. Following training, structured implicit case reviews will be conducted by consultants or senior registrars (senior residents) in acute medical specialities (60 case records per reviewer), and limited to the first 7 days following hospital admission. The co-primary outcomes are the weekend:weekday admission ratio of errors per case record, and a global assessment of care quality on a Likert scale. Error rates will be analysed using mixed effects logistic regression models, and care quality using ordinal regression methods. Secondary outcomes include error typology, error-related adverse events and any correlation between error rates and staffing. The data will also be used to inform a parallel health economics analysis.Ethics and disseminationThe project has received ethics approval from the South West Wales Research Ethics Committee (REC): reference 13/WA/0372. Informed consent is not required for accessing anonymised patient case records from which patient identifiers had been removed. The findings will be disseminated through peer-reviewed publications in high-quality journals and through local High-intensity Specialist-Led Acute Care (HiSLAC) leads at the 121 hospitals that make up the HiSLAC Collaborative.

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

“…This must include care in the community, hospital admission decisions and quality of care in hospital following admission. The last of these is being addressed through the HiSLAC programme 26. Examining community care processes should be included in the UK policy initiative of integrating social care in the remit of the Department of Health, supported by the recent set of guidelines on integrating acute and emergency care published by the National Institute for Health and Care Excellence 27…”

The provision of seven day multidisciplinary staffing in Scottish acute medical units: a cross-sectional study

“…It is therefore unclear how generalisable the findings of this Scottish study are to the wider UK setting. This will be further informed by similar studies undertaken outside Scotland, such as the one currently underway in NHS England 13 . The relevance of this work to other European and Australasian settings is also unclear.…”

Changes in weekend and weekday care quality of emergency medical admissions to 20 hospitals in England during implementation of the 7-day services national health policy

“…Trusts were classified first into quintiles of size (acute beds) and then four were selected from within each quintile, two with the highest and two with the lowest Sunday specialist intensity (2014 data) (online supplemental table 1). Data on specialist intensity (hours of consultant time per 10 emergency admissions) were derived from the HiSLAC national point prevalence survey conducted annually on a Sunday and a Wednesday in June between 2014 and 2018 20 (data on specialist intensity for the 5 years is in press, Health Services and Delivery Research Journal 2020). Following an on-site initiation visit, each Trust provided an anonymised and hash-encrypted Patient Administration System (PAS) dataset for all admissions during two epochs, financial year 1 April 2012-31 March 2013 and 1 April 2016-31 March 2017.…”