11 Dr Foster Intelligence Variation in hospital services at weekends.

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Presentation transcript:

11 Dr Foster Intelligence Variation in hospital services at weekends

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55 Other papers Cavallazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of admission to the ICU and mortality: a systematic review and metaanalysis. Chest. 2010;138(1):68–75. Marco J, Barba R, Plaza S, Losa JE, Canora J, Zapatero A. Analysis of the mortality of patients admitted to internal medicine wards over the weekend. Am J Med Qual. 2010;25(4):312–318. Kuijsten HA, Brinkman S, Meynaar IA, et al. Hospital mortality is associated with ICU admission time. Intensive Care Med Jun 15 (E pub ahead of print) PubMed PMID: Dorn SD, Shah ND, Berg BP, Naessens JM. Effect of weekend hospital admission on gastrointestinal hemorrhage outcomes. Dig Dis Sci. 2010; 55(6):1658–1666. James MT, Wald R, Bell CM, et al. Weekend hospital admission, acute kidney injury, and mortality. J Am Soc Nephrol. 2010;21(5):845–851. Schilling PL, Campbell DA Jr., Englesbe MJ, Davis MM. A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. Med Care. 2010;48(3):224–232. Horwich TB, Hernandez AF, Liang L, et al.Get With Guidelines Steering Committee and Hospitals. Weekend hospital admission and discharge for heart failure: association with quality of care and clinical outcomes. Am Heart J. 2009;158(3):451–458. Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol. 2009;7(3):303– 310. Aujesky D, Jimenez D, Mor MK, Geng M, Fine MJ, Ibrahim SA. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation. 2009;119(7):962–968.

6 Page 6 Explanations Patients Fewer discharges to alternative place of death People wait longer before seeking help / admission thresholds raised Staff Fewer Less experienced More exhausted Available services Diagnostics Specialist interventions

77 Hospital guide data Mortality rates weekend vs weekdays HSMR Emergency and Elective HSMR Measures of process Time to operation Number of discharges Procedures performed Staffing levels Medical staff on site and on call by grade at weekends and nights Nurses and nurse assistants on care of the elderly wards at weekends and nights RTM v2 May 09

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18 Page 18 Staffing data Collected by questionnaire distributed to all acute NHS trusts Communication with assigned trust representative and confirmed with CEO Questionnaires distributed in June and completed by September Forms filled in online and data returned in printable format for validation and sign off Data returned for 190 acute hospitals 36 were unable to provide data on scheduled staff but could provide data on actual staff

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25 Page 25 Some issues with staffing data Staff grade doctors and registrars at non-teaching hospitals Role of on-call doctors Is this a site or trust issue? The role of “satellite” A&E units – e.g. Princess Royal in Sussex – and public understanding of service provision Night staffing

26 Page 26 Comments and questions