Variation in Hospital Services at Weekends-Roger

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Variation in hospital services at weekends
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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. 2010 Jun 15 (E pub ahead of print) PubMed PMID: 20549184.
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.
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Explanations
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Patients
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Fewer discharges to alternative place of death
People wait longer before seeking help / admission thresholds raised
Staff
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Fewer
Less experienced
More exhausted
Available services
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Diagnostics
Specialist interventions
Hospital guide data
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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
Proportion of total discharges which occur on a Saturday or Sunday
<99.8% CL
Within 99.8% CL
>99.8% CL
% of total discharges which occur on a Saturday or Sunday
25%
20%
15%
10%
5%
0%
RA3
5QT
RQ6 RGP RR7 RHQ RBZ RBA RVW RJR RDD RGR RVY
RAJ RWJ RCB RTR RNQ RC9
RLT RW6 RXW RTX RCD RDE RV8 RYR
Trust
8
RJE RWW RTG RNA RN7 RNZ RRV RD3 RPA RWA RJF
RF4
RJ7
RHU RMC RWP RXQ RM1 RAS RC3
RA9 RNH
Proportion of emergency spells with a discharge on a Saturday or Sunday
<99.8% CL
Within 99.8% CL
>99.8% CL
% of emergency spells with a discharge on a Saturday or
Sunday
25%
20%
15%
10%
5%
0%
RA3
RFF
RJL REM RR7 RLN RDD RCC RC1
RL4
RXC RBD RVW RFS RXQ RBA RBZ
RC9 RNL
RA4 RGN RCF
Trust
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RJC
RXL
RTF RWJ RXP RTX
RN7 RW6 RQ8 RR1
RXF
RJZ
RD7
RD3 RRV RVV
RJ7
RM3 RAS RTH RXK RWA RBT
RJN RNH RDU RRF
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Staffing data
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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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RYJ03
RXK02
RRV03
RXPCP
RWEAA
RWH01
RGCKH
RBK02
Senior staff call / 100 beds
RJE02
Senior Staff site / 100 Beds
RXQ50
RYQ30
RRF02
RVY01
RH801
RYR16
RJL32
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0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
Senior staff call / 100 beds vs senior staff on site / 100 beds
14.00
12.00
10.00
8.00
Senior staff call / 100 beds
Linear (Senior staff call / 100 beds)
6.00
y = 0.2128x + 2.4834
R² = 0.0232
4.00
2.00
0.00
0.00
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1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
Senior Staff per bed at weekend vs weekend HSMR
120.0
More Senior staff per bed
100.0
Weekend HSMR
80.0
60.0
40.0
20.0
0.0
Lower Quartile
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Middle
Upper quartile
Senior staff as a % of all medical staff vs HSMR
120.0
More Senior staff per bed
100.0
Weekend HSMR
80.0
60.0
40.0
20.0
0.0
Lower Quartile
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Middle
Upper quartile
Staff Grade Drs as a percentage of all Drs
120.0
More staff Grades on Duty
100.0
Weekend HSMR
80.0
60.0
40.0
20.0
0.0
Lower Quartile
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Middle
Upper quartile
Some issues with staffing data
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Staff grade doctors and registrars at non-teaching hospitals
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Role of on-call doctors
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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
Comments and
questions
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Page 26
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