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.
Author
Bion, JulianAldridge, Cassie
Girling, Alan J
Rudge, Gavin
Sun, Jianxia
Tarrant, Carolyn
Sutton, Elizabeth
Willars, Janet
Beet, Chris
Boyal, Amunpreet
Rees, Peter
Roseveare, Chris
Temple, Mark
Watson, Samuel Ian
Chen, Yen-Fu
Clancy, Mike
Rowan, Louise
Lord, Joanne
Mannion, Russell
Hofer, Timothy
Lilford, Richard
Publication date
2020-10-28Subject
Intensive careGastroenterology
Nephrology/Renal medicine
Public health. Health statistics. Occupational health. Health education
Metadata
Show full item recordAbstract
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.Citation
Bion J, Aldridge C, Girling AJ, Rudge G, Sun J, Tarrant C, Sutton E, Willars J, Beet C, Boyal A, Rees P, Roseveare C, Temple M, Watson SI, Chen YF, Clancy M, Rowan L, Lord J, Mannion R, Hofer T, Lilford R. 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. BMJ Qual Saf. 2021 Jul;30(7):536-546. doi: 10.1136/bmjqs-2020-011165. Epub 2020 Oct 28Type
ArticleOther
Additional Links
http://qualitysafety.bmj.comPMID
33115851Journal
BMJ Quality & SafetyPublisher
BMJ Publishing Groupae974a485f413a2113503eed53cd6c53
10.1136/bmjqs-2020-011165
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