Patients admitted to hospital in an emergency at weekends have been found to experience higher mortality rates than those admitted during the week. The NHS in England has introduced four priority clinical standards for emergency hospital care with the objective of reducing the deaths associated with this ‘weekend effect’. This study aimed to determine whether adoption of these clinical standards is associated with the extent to which weekend mortality is elevated.
We utilise publicly available data on performance against the four priority clinical standards in 2015 and estimates of Trusts’ weekend effects between 2013/14 and 2015/16 for 123 NHS Trusts in England. We examine whether adoption of the priority clinical standards is associated with the extent to which weekend mortality is elevated, and changes over a three-year period in the extent to which mortality is elevated.
The levels of achievement of two of the four clinical standards (on-going review and access to diagnostic services) have small positive associations with the magnitude of the weekend effect in 2015/16. The levels of achievement of the remaining two standards (time to first consultant review and access to consultant-directed interventions) have small negative associations with the magnitude of the weekend effect in 2015/16. No association is statistically significant. The same pattern is observed in the associations between achievement of the standards and the changes in the magnitudes of the weekend effect between 2013/14 and 2015/16.
We found no association between Trusts’ performance against any of the four standards and the current magnitude of their weekend effects, or the change in their weekend effects over the last three years. These findings cast doubt on whether the adoption of seven-day clinical standards in the delivery of emergency hospital services will be successful in reducing the weekend effect.