A&E deaths higher at weekends

Patients admitted to A&E over the weekend are nearly 10 per cent more likely to die, according to a new report.

The weekend spike in deaths seen is most likely caused by some hospitals having fewer senior doctors working in A&E at weekends, the time taken to be treated and less consistent specialised services, research by the health information company Dr Foster found.

The 2011 edition of The Hospital Guide for the first time includes levels of medical staffing in 147 NHS hospital trusts in England at nights and weekends.

The report investigated death rates in hospitals using four key measures - overall hospital deaths; deaths within 30 days of being discharged from hospital; deaths following surgery and deaths linked to conditions where patients would normally survive.

Of 147 trusts, the report identified 19 hospital trusts with higher than expected mortality rates using two measures - overall hospital deaths and deaths within 30 days of discharge.

Using both measures to look at hospital death rates was thought to be a more fair assessment as some people may choose to go to hospital at the end of their life, which would increase the hospital death rate figures.

However, another 21 trusts had lower than expected mortality rates, with the Chelsea and Westminster Foundation Trust having lower rates on all four measures, which the report described as "impressive."

When it came to people admitted to hospital for emergency treatment, 18 trusts had higher than expected mortality rates at weekends.

Overall, the death rate at weekends was 8.1 per cent compared with 7.4 per cent on weekdays, a difference of 9.5 per cent.

Reasons behind this included fewer senior doctors on-call at the weekend and less consistent specialist services such as those provided by diagnostic departments. "More senior doctors as a percentage of all doctors is associated with a lower weekend emergency mortality rate," the report stated.

The report also identified 39 hospital trusts which performed fewer than 35 operations a year for abdominal aortic aneurysms. As the death rate for "low volume" hospitals are 70 per cent higher compared with busier hospitals, the report suggested they should either increase the number of procedures performed or stop carrying out the operations altogether.

Roger Taylor, director of research and co-founder of Dr Foster said: "A safe NHS is an NHS that provides care 24/7.

"It is concerning that many of the issues raised in the first Hospital Guide remain problems ten years later: hospitals performing low volumes of surgery where high levels are needed to ensure good outcomes, and hospitals failing to meet the best standards of care despite many years of evidence of the impact this has on patients.

"However, fewer people died in 2009 than in any year since the mid 1950s – despite the population being larger and older.

"A large part of that success is down to improvements in care with in-hospital mortality rates falling steadily over the last 10 years since we first published the Hospital Guide."

This article was published on Mon 28 November 2011