Responses

Download PDFPDF

Moving beyond the weekend effect: how can we best target interventions to improve patient care?
Free
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • Responses are moderated before posting and publication is at the absolute discretion of BMJ, however they are not peer-reviewed
  • Once published, you will not have the right to remove or edit your response. Removal or editing of responses is at BMJ's absolute discretion
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication and send them to the editorial office before submitting your response [Patient consent forms]
  • By submitting this response you are agreeing to our full [Response terms and requirements]

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    Professor Julian Bion
    • Julian F Bion, Professor of Intensive Care Medicine University of Birmingham

    We thank Professors Marang-van de Mheen and Vincent for their comments [1] on our examination of variations in weekend and weekday admission care quality during the introduction of seven day services in England [2]. Their analysis and logic models demonstrate with admirable simplicity the complexity of these causal pathways.
    One of the pathways which is not highlighted in the literature is how quality of pre-hospital care may impact on the post-admission phase in hospital. Using exploratory data from the 20 hospitals in our data set, we have shown that while in-hospital care quality did not vary between weekend and weekday admissions, and had improved over time, there was a concurrent deterioration in performance indicators related to care in the community preceding hospital admission. Weekend admissions were much less likely to have been referred by family doctors, and more likely to attend hospital by emergency ambulance, to be dependent on others for activities of daily living, and to be candidates for palliative care. These differences became more marked with the passage of time. In a separate single-centre study we have shown that patients admitted at weekends are sicker than those admitted on weekdays [3]. We therefore contend that while there may be opportunities to improve hospital care across all days of the week, the cause for the weekend effect may reside in community healthcare services. As the weekend effect is a global phenomenon [4], policy makers a...

    Show More
    Conflict of Interest:
    None declared.