Variations in care quality occur across the whole week, not just at weekends

The “weekend effect” is an oversimplification.1 Attempting to address it is a distraction because hospital mortality is not a good measure of quality of care and weekends are not the only times when quality is compromised by the way in which services are organised.

What we need to know is, firstly, are there variations in quality of care depending on the time of day or the day of the week that emergency patients are admitted? Secondly, are these variations clinically important? Thirdly, if they are important, what are the underlying causes and, fourthly, does the NHS want to make the changes and investment that are necessary to deal with the causes?

We think that we can answer the first and second questions, at least for some groups of patients, using data from national clinical audits. Patients with stroke receive high …