Higher death rate among hospital patients admitted at weekends has several causes, report finds

BMJ 2011; 343 doi: (Published 30 November 2011) Cite this as: BMJ 2011;343:d7791
  1. Nigel Hawkes
  1. 1London

Patients admitted to hospitals as emergency cases at weekends have a greater chance of dying than those admitted during the week, concludes the health analysis company Dr Foster.

The reason could be a different patient mix caused by a lack of community and primary care services at the weekend, a lack of consultants on the wards, or changed staffing levels. The difference, says Dr Foster in its 2011 hospital guide, is “worrying”: while the overall death rate for emergency admissions is 7.4% during the week, it is 8.1% at weekends.

Dr Foster obtained data from 130 trusts on staffing levels on two random Thursdays in March and April 2011 and for the two following Sundays. The analysis found that having more senior staff per bed at weekends was associated with lower weekend emergency mortality and that hospitals with more senior doctors as a proportions of all doctors also had lower weekend mortality.

Some hospitals whose hospital standardised mortality ratios were in the normal range during the week had higher than normal ratios at weekends. Mortality ratios were significantly higher among trusts with the fewest doctors.

Richard Thompson, president of the Royal College of Physicians, said, “At last we have data that clearly link higher numbers of senior doctors in hospitals at the weekend with lower mortality rates. We must ensure that consultant numbers continue to increase to allow higher levels of staffing at the weekend in all hospitals.”

In 2010 the college recommended that any hospital admitting acutely ill patients should have a consultant physician on site for at least 12 hours a day, seven days a week. “At a time when finances are tight, hospitals will be freezing the number of staff as a way to save money, but we must ensure this does not happen,” Sir Richard said.

This year the hospital guide includes private sector hospitals and an analysis of comments left by patients on the NHS Direct and patient opinion websites. Private sector hospitals feature strongly among the top 10 most likely to be recommended by patients, and the guide finds that a lack of respect and not being kept informed are the two main reasons why patients would not recommend the hospital they attended, ahead of issues such as cleanliness and single sex wards.

David Worskett, director of the NHS Partners Network, which represents independent sector hospitals that work for the NHS, said, “The data clearly confirm that independent sector facilities are among the best for provision of NHS care, and this endorses what independent patient ratings have already shown.”


Cite this as: BMJ 2011;343:d7791