RT Journal Article
SR Electronic
T1 Changes in weekend and weekday care quality of emergency medical admissions to 20 hospitals in England during implementation of the 7-day services national health policy
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 536
OP 546
DO 10.1136/bmjqs-2020-011165
VO 30
IS 7
A1 Julian Bion
A1 Cassie Aldridge
A1 Alan J Girling
A1 Gavin Rudge
A1 Jianxia Sun
A1 Carolyn Tarrant
A1 Elizabeth Sutton
A1 Janet Willars
A1 Chris Beet
A1 Amunpreet Boyal
A1 Peter Rees
A1 Chris Roseveare
A1 Mark Temple
A1 Samuel Ian Watson
A1 Yen-Fu Chen
A1 Mike Clancy
A1 Louise Rowan
A1 Joanne Lord
A1 Russell Mannion
A1 Timothy Hofer
A1 Richard Lilford
YR 2021
UL http://qualitysafety.bmj.com/content/30/7/536.abstract
AB Background In 2013, the English National Health Service launched the policy of 7-day services to improve care quality and outcomes for weekend emergency admissions.Aims To determine whether the quality of care of emergency medical admissions is worse at weekends, and whether this has changed during implementation of 7-day services.Methods Using data from 20 acute hospital Trusts in England, we performed randomly selected structured case record reviews of patients admitted to hospital as emergencies at weekends and on weekdays between financial years 2012–2013 and 2016–2017. Senior doctor (‘specialist’) involvement was determined from annual point prevalence surveys. The primary outcome was the rate of clinical errors. Secondary outcomes included error-related adverse event rates, global quality of care and four indicators of good practice.Results Seventy-nine clinical reviewers reviewed 4000 admissions, 800 in duplicate. Errors, adverse events and care quality were not significantly different between weekend and weekday admissions, but all improved significantly between epochs, particularly errors most likely influenced by doctors (clinical assessment, diagnosis, treatment, prescribing and communication): error rate OR 0.78; 95% CI 0.70 to 0.87; adverse event OR 0.48, 95% CI 0.33 to 0.69; care quality OR 0.78, 95% CI 0.70 to 0.87; all adjusted for age, sex and ethnicity. Postadmission in-hospital care processes improved between epochs and were better for weekend admissions (vital signs with National Early Warning Score and timely specialist review). Preadmission processes in the community were suboptimal at weekends and deteriorated between epochs (fewer family doctor referrals, more patients with chronic disease or palliative care designation).Conclusions and implications Hospital care quality of emergency medical admissions is not worse at weekends and has improved during implementation of the 7-day services policy. Causal pathways for the weekend effect may extend into the prehospital setting.Data are available on reasonable request. We are willing to share our data for collaborative research.