Research News

Weekend admission to psychiatric hospital is not linked to increased risk of death

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2342 (Published 25 April 2016) Cite this as: BMJ 2016;353:i2342
  1. Jacqui Wise
  1. London

Being admitted to a psychiatric hospital at the weekend is not associated with a higher risk of death than admission during the week, research published in the British Journal of Psychiatry has found.1 However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that weekend patients have ongoing, unresolved treatment needs.

The finding is topical because of the government’s pledge to implement full seven day working in the NHS and impose a new contract on junior doctors. England’s health secretary, Jeremy Hunt, has repeatedly said that excess deaths at weekends are a result of poor staffing, although commentators, including The BMJ’s editor in chief, have castigated him for misusing data.2

The new study examined whether patients admitted to psychiatric hospitals at the weekend are at increased risk of death. Researchers used electronic health records from patients admitted to a psychiatric hospital in the South London and Maudsley NHS Foundation Trust, which provides mental healthcare services for an area of around 1.2 million people.

Data were obtained from 45 264 consecutive psychiatric hospital admissions, of which 7303 (16.1%) were at a weekend. Patients who were young (aged 26-35), female, and from an ethnic minority were more likely to be admitted at the weekend—consistent with data on patients who were admitted to acute hospitals at weekends. Most patients admitted during the week were admitted from home (91.9%), whereas those admitted at the weekend were more likely to present through acute hospital services, other psychiatric hospitals, or the criminal justice system.

Patients admitted at the weekend spent around 21 fewer days in hospital than patients admitted during the week and had a 13% higher chance of readmission in the 12 months after discharge. However, inpatient mortality after weekend admission was not greater than after weekday admission (odds ratio 0.79 (95% confidence interval 0.51 to 1.23); P=0.30). The overall rate of inpatient deaths was 6.2 per 1000 admissions—much lower than has been found in studies at acute hospitals providing physical healthcare (46 deaths within 30 days per 1000 admissions), where patients are more likely to be admitted with immediately life threatening medical disorders.3

Rashmi Patel, study author, from the Institute of Psychiatry, Psychology and Neuroscience at King’s College, London, said, “We found that patients admitted to a psychiatric hospital at the weekend were younger than those admitted during the week, and therefore at lower risk of physical health problems which could increase their risk of death.

“However, after accounting for age and other demographic factors, we found that there was no statistically significant difference in risk of death between patients admitted at the weekend compared to during the week.”

He added, “We also found that weekend patients had shorter admissions and increased risk of readmission, which may suggest that they had ongoing, unresolved treatment needs related to a lack of community and social care services at the weekend. This highlights the need to consider not only the provision of mental healthcare services but also community and social care services across the week.”

References

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