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

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4596 (Published 05 September 2015) Cite this as: BMJ 2015;351:h4596

Rapid Response:

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

Dear BMJ,

The authors are to be congratulated for collecting an incredible amount of data on an interesting topic. Unfortunately, although enthusiastically published, their paper now appears to be failing the informal peer review process, as witnessed by the online rapid responses. Why is this?

Is it because the methodology and results are flawed and opaque respectively? Is it the explicit and unjustified assertion from the title onwards that this relates to staffing? Is it the suggestion that the data were released to the government prior to publication for political gain? Is it the uncertain logic that redefines friday and monday as weekend days? All of these justifiable criticisms have been adequately elaborated upon by other responders, without satisfactory answer.

Although conceding that the patients admitted on the weekend may be sicker, there does not appear to be sufficient measurement or adjustment for this factor, beyond their premorbid and demographic characteristics. By comparison, ICNARC collects detailed data with regards illness severity on admission to intensive care, yet still does not feel able to reasonably compare standards of care between centres. Other studies (such as Hogan et. al, published this year in this journal) have suggested that in hospital mortality is rarely preventable, and is not a satisfactory method of comparing standards of care. With this in mind, why does the limited analysis of this paper feel able to make its assertions, and indeed, suggest ‘a case for seven day services'? The data collected could have been highly useful, but unfortunately now its limited conclusions are being used largely to influence the faltering negotiations on the working conditions of the nation’s doctors. It is tempting to think that this may have been the primary intention, and a review of the references supplied does little to dispel this concern.

Seventeen years ago the now infamous paper linking the MMR vaccine with autism was published, with similar enthusiasm. Today there is renewed discussion of the potential deleterious effect of journalism on healthcare behaviours, popularised as ‘the Hunt Effect’. It took twelve years before the MMR paper was fully retracted by the Lancet; could this paper result in similar tragedy?

Competing interests: I am a junior doctor and a member of the British Medical Association

18 October 2015
John R Kiely
Surgical Trainee Doctor
University Hospital Southampton
Southampton