Intended for healthcare professionals


Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

BMJ 2015; 351 doi: (Published 05 September 2015) Cite this as: BMJ 2015;351:h4596

This article has a correction. Please see:

  1. Nick Freemantle, professor of clinical epidemiology and biostatistics12,
  2. Daniel Ray, professor of health informatics234,
  3. David McNulty, medical statistician23,
  4. David Rosser, medical director5,
  5. Simon Bennett, director, clinical policy and professional standards6,
  6. Bruce E Keogh, national medical director6,
  7. Domenico Pagano, professor, cardiac surgery27
  1. 1Department of Primary Care and Population Health, University College London, UK
  2. 2Quality and Outcomes Research Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3Department of Informatics, University Hospitals Birmingham NHS Foundation Trust
  4. 4Farr Institute of Health Informatics Research, University College London
  5. 5University Hospitals Birmingham NHS Foundation Trust
  6. 6Medical Directorate, NHS England, London, UK
  7. 7Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust
  1. Correspondence to: D Pagano Domenico.Pagano{at}
  • Accepted 19 August 2015

Nick Freemantle and colleagues discuss the findings of their updated analysis of weekend admissions and the implications for service design

Any modern, effective healthcare system should prevent premature deaths from treatable causes, improve quality of life for people with long term conditions, aid recovery from acute conditions, and ensure safe care. At the same time it should provide patients with as positive an experience as reasonably possible. Intuitively, reduced provision of healthcare at weekends adversely affects all of these domains. The relation between service organisation across the week and excess mortality cannot be easily studied using randomised controlled trials, so the evidence base for designing healthcare services relies on an observational approach.

Our previous study of all NHS hospital admissions in England during the financial year 2009-10 indicated that admission at the weekend (Saturday and Sunday) was associated with a significantly increased risk of in-hospital death compared with midweek admission, but being in hospital at the weekend was associated with reduced risk of death.1 These findings were replicated in an analysis of 254 leading hospitals in the US.1

Because six years have elapsed since our last assessment of weekend mortality we have updated our analysis using data from NHS English hospitals and on related deaths in 2013-14. The original analysis was built on our previous work developing the QUORUM metric for comparing hospital death rates.2 This metric identified that the risk of death is highly predictable in NHS admissions. The three main objectives of the current analysis were to characterise the patient population admitted at weekend; examine whether, after robust adjustment for case mix, weekend admission carries an increased 30 day mortality risk compared with midweek admission; and estimate whether mortality risk differs between hospital stay at weekends and during the week.

Survivorship models

We used identical methods to …

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