Re: Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics
Aylin and colleagues offer an interesting analysis which provides further evidence that the weekend management of postoperative patients could be improved [1], and moves to further strengthen the argument that the NHS should deliver a 24/7 service [2].
It is a shame that Saturday and Sunday patients were grouped for analysis. If they had been analysed separately, one would have expected the Sunday patients to have lower mortality than those whose operation was performed on Saturday, needing only to survive one day of the “weekend effect” instead of two. In fact, if the observed differences in survival are thought to be related to post-operative factors (particularly the 48 hour window described by Cavaliere et al [3]) the highest risk patient should be the one last on Friday’s list – required to survive the entire weekend before the normal team return.
The media reaction to this article, however, fails to appreciate that the authors conclude “the reasons behind this [increased mortality] remain unknown” [1].
Although the article suggests that the increased mortality could be due to reduced and/or locum staffing, newspaper reports jump to lay the blame at the feet of the junior doctors working at the weekend.
“It is what doctors don’t tell you: avoid falling sick over the weekend, when senior doctors are off duty and hospitals are run by a skeleton staff” [4] leads The Independent, painting a picture of a demonic horde of junior doctors, leaderless, running amok through the hospital in a scene akin to William Golding’s Lord of the Flies.
Both of the hospitals (forgive my inexperience) that I have worked in have reduced numbers of junior doctors caring for surgical inpatients over the weekend compared to the week. Statements such as "The junior doctors, they're always around, but they're not the ones making a difference here" [5] from Dr Foster’s Roger Taylor (2011), are misleading and unhelpful, and serve to undermine the public’s trust in junior doctors.
Junior doctors do not plan the staffing levels in hospitals; we do not want to work in under-supported conditions, and we did not design the now infamous “EWTD”.
The vast majority of junior doctors I know return home from a busy weekend shift having worked hard, fighting fires to try to keep their patients well until Monday.
It is time that senior NHS figures moved to defend junior doctors for the hard work that they do put in out of hours.
1. Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics. BMJ 2013;346:f2424
2. Should the NHS work at weekends as it does in the week? Yes. BMJ 2013;346:f621
3. Cavaliere F, Conti G, Costa R, Masieri S, Antonelli M, Proietti R. Intensive care after elective surgery: a survey on 30-day postoperative mortality and morbidity. Minerva Anestesiol 2008;74:459-68.
Rapid Response:
Re: Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics
Aylin and colleagues offer an interesting analysis which provides further evidence that the weekend management of postoperative patients could be improved [1], and moves to further strengthen the argument that the NHS should deliver a 24/7 service [2].
It is a shame that Saturday and Sunday patients were grouped for analysis. If they had been analysed separately, one would have expected the Sunday patients to have lower mortality than those whose operation was performed on Saturday, needing only to survive one day of the “weekend effect” instead of two. In fact, if the observed differences in survival are thought to be related to post-operative factors (particularly the 48 hour window described by Cavaliere et al [3]) the highest risk patient should be the one last on Friday’s list – required to survive the entire weekend before the normal team return.
The media reaction to this article, however, fails to appreciate that the authors conclude “the reasons behind this [increased mortality] remain unknown” [1].
Although the article suggests that the increased mortality could be due to reduced and/or locum staffing, newspaper reports jump to lay the blame at the feet of the junior doctors working at the weekend.
“It is what doctors don’t tell you: avoid falling sick over the weekend, when senior doctors are off duty and hospitals are run by a skeleton staff” [4] leads The Independent, painting a picture of a demonic horde of junior doctors, leaderless, running amok through the hospital in a scene akin to William Golding’s Lord of the Flies.
Both of the hospitals (forgive my inexperience) that I have worked in have reduced numbers of junior doctors caring for surgical inpatients over the weekend compared to the week. Statements such as "The junior doctors, they're always around, but they're not the ones making a difference here" [5] from Dr Foster’s Roger Taylor (2011), are misleading and unhelpful, and serve to undermine the public’s trust in junior doctors.
Junior doctors do not plan the staffing levels in hospitals; we do not want to work in under-supported conditions, and we did not design the now infamous “EWTD”.
The vast majority of junior doctors I know return home from a busy weekend shift having worked hard, fighting fires to try to keep their patients well until Monday.
It is time that senior NHS figures moved to defend junior doctors for the hard work that they do put in out of hours.
peter.thomson1@nhs.net
1. Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics. BMJ 2013;346:f2424
2. Should the NHS work at weekends as it does in the week? Yes. BMJ 2013;346:f621
3. Cavaliere F, Conti G, Costa R, Masieri S, Antonelli M, Proietti R. Intensive care after elective surgery: a survey on 30-day postoperative mortality and morbidity. Minerva Anestesiol 2008;74:459-68.
4. http://www.independent.co.uk/life-style/health-and-families/health-news/...
5. http://www.bbc.co.uk/news/health-15895663
Competing interests: I am a current Foundation Year 2 doctor.