BMJ Group AwardsBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b325 (Published 29 January 2009) Cite this as: BMJ 2009;338:b325
All rapid responses
I was more than a little suprised to see the nomination of the
'Hospital at Night team' in the category 'Excellence in Learning and
Education'. I was also interested to see the following claim made in the
desription of the scheme:
'The programme enhances patient safety and outcomes and supports
medical training and service delivery'
In fact when Hospital at Night schemes were first piloted in a few
handpicked hospitals mortality actually increased, however this was not a
statistically significant change but the numbers were small. No other
patient outcomes were measured at this point I believe.
The Hospital at Night team has since produced a report that has
looked at patient outcomes in only slightly more detail (1). In fact the
only conclusions relating to outcomes are described in the report as
'Appearing to show it is as safe as other forms of care' and 'Reducing the
number of deaths within two days of admission and reducing the number of
deaths within twodays of surgery/procedure - the reduction in the sites
studied was greater than the all England average'. The former statement
is only claiming HaN to be the same in terms of patient safety and the
latter is misleading at best, I shall explain this.
The change in deaths was described in the report in more detail 'When
analysed against the England percentage change position, seven trust sites
were below the England average and five trust sites had a relative
increase'. This is hardly conclusive evidence that HaN is improving
patient safety and/or patient outcomes. There is surprisingly no mention
of statistical significance.
It should also be noticed that the report states 'The trend shows a
marginal overall increase in the ‘actual numbers’ of deaths, in both
activity sets'. I wonder why this statistically insignificant increase
showing a potential negative impact of HaN is not mentioned in the report
summary which states that the report 'indicates positive movement towards
improved patient outcomes'.
In actual fact this report on outcomes is a small study with several
methodological flaws which at best shows HaN to have had no effect on
patient safety or patient outcomes. There is nothing conclusive or
statistically signficant within it that shows any improvement in patient
outcomes. This directly contradicts claims made on both the HaN website
and in the description of HaN by the BMJ in its nomination for this award.
In conclusion I feel there is no decent evidence to suggest that HaN
has improved any patient outcomes, while it appears that as a new scheme
HaN should have been far more rigorously monitored on its introduction in
terms of patient outcomes than it actually was. I fail to be convinced
that HaN deserves a nomination in this category.
1. Hosptial at Night team. The Case for Hospital at Night
- The Search for Evidence.
Competing interests: No competing interests