Higher Weekend Death Rate Paradigm Cast in Doubt

A new study concludes that the higher death rate following weekend hospital admission reflects a lower probability of admission.

Researchers at the University of Manchester (United Kingdom) and the University of York (United Kingdom) conducted a retrospective observational study of all 140 non-specialist acute hospital Trusts in England, analyzing 12,670,788 accident and emergency (AE) department attendances and 4,656,586 emergency room (ER) admissions between April 2013 and February 2014. Emergency attendances, admissions to hospital, and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends.

The results revealed that a similar numbers of patients attended the AE department on weekends and weekdays, with a similar numbers of deaths amongst weekend (378) and weekday (388) patients. The results also showed that a proportionately smaller number of patients who attended the AE department at the weekend were admitted to hospital, and it was only amongst those patients that the probability of dying was significantly higher at the weekend.

In addition, the average volume of direct admissions from the AE department was 61% lower on weekend days (1,317), as compared to weekdays (3,404), and that there were fewer deaths following direct admission on weekend days than weekdays (35.9 versus 80.8). The researchers therefore concluded that the mortality rate was significantly higher at weekends amongst direct admissions due to the proportionately greater reduction in admissions, relative to deaths. The study was published on May 6, 2016, in Journal of Health Services Research and Policy.

“Hospitals apply a higher severity threshold when choosing which patients to admit to hospital at weekends; patients with non-serious illnesses are not admitted, so those who are admitted at the weekend are on average sicker than during the week, and more likely to die regardless of the quality of care they receive,” said senior author Professor Matt Sutton, PhD, of the University of Manchester. “As a result, the figures comparing death rates at weekends and weekdays are skewed.”

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