Intended for healthcare professionals

Letters The weekend effect

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

BMJ 2016; 353 doi: (Published 07 June 2016) Cite this as: BMJ 2016;353:i3151
  1. Kevin Stewart, clinical director, clinical effectiveness and evaluation unit1,
  2. Ben Bray, quality improvement fellow, clinical standards1,
  3. Rhona Buckingham, operations director, clinical effectiveness and evaluation unit1,
  4. Chris Boulton, project manager, clinical standards1
  1. 1Royal College of Physicians, London NW1 4LE, UK
  1. kevin.stewart{at}

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 …

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