BMJ Qual Saf 23:180-182 doi:10.1136/bmjqs-2013-002674
  • Editorial

It's not you, it's me: time to narrow the gap in weekend care

  1. Chaim M Bell
  1. Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Chaim M Bell, Department of Medicine, Mount Sinai Hospital, Suite 433, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5; cbell{at}
  • Received 15 November 2013
  • Accepted 15 November 2013
  • Published Online First 3 December 2013

Numerous studies1–6 have now described the ‘weekend effect’ and its negative impact on timeliness of inpatient care and mortality. Patients presenting with numerous medical and surgical problems experience better outcomes if they happen to arrive in hospital on a workday versus a weekend day. Researchers have highlighted the problem as reflecting reduced staffing and decreased access to specialised services at the weekend. Remarkably, the weekend effect was recently found to extend even to elective admissions and surgeries, raising major questions about resource planning around elective care that occurs near the end of the week.7 ,8

Perez Concha et al9 analysed administrative data from Australian hospitals between 2000 and 2007. They compared 7-day mortality after hospital admission in patients admitted during the weekend versus a weekday, stratifying their analysis by diagnostic group. They defined the weekend as occurring between midnight on Friday and midnight on Sunday. Their analysis included ORs for death after weekend versus weekday admission, as well as survival curves and HRs.

In all, 16 of 430 diagnostic groups showed evidence of a weekend effect for 7-day patient mortality. No conditions demonstrated an ‘inverse weekend effect’, or decreased mortality over the weekend relative to the work week. In addition to risk ratios, the authors present the absolute number of excess deaths for each condition. All together, these conditions account for 21 excess deaths per 1000 patient admissions. Adjustment for differences in case mix between weekend and weekday groups surprisingly increased the magnitude of the observed weekend …

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