If you’re going to get sick, make sure it’s on a Monday: Research reveals death rates are higher for operations performed on Thursdays and Fridays
Death rates are 44 per cent higher following operations on a Friday than at the beginning of the week
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Wednesday 29 May 2013
It is what doctors don’t tell you: avoid falling sick over the weekend, when senior doctors are off duty and hospitals are run by a skeleton staff.
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Now researchers have found the curse of the weekend extends backwards through the week.
A study has shown that patients undergoing routine surgery were at lowest risk if their operation was carried out on a Monday and at progressively higher risk as the week progressed.
Death rates were 44 per cent higher following operations on a Friday than at the beginning of the week, according to the first large study of the link between surgical mortality rates and the day of operation.
The risk increased each day from Monday to Friday with a sudden leap at the weekend. Surgery on Saturdays and Sundays carried an 82 per cent higher mortality rate.
Raised death rates following weekend surgery are well known but this is the first time surgery has been shown to be increasingly risky as the week progresses.
Experts from Imperial College, London, who analysed more than four million operations and over 27,000 deaths following surgery in England between 2008/9 and 2010/11, say the reasons are likely to be fewer staff with less experience caring for patients in the crucial 48 hours following surgery, when that stretches over the weekend.
The authors say: “Our hypothesis was that if there is a quality of care issue at weekend then we would expect to see higher mortality at the weekend. Importantly we would also expect to see higher mortality in other patients who have their procedure just before the weekend and whose immediate post-operative period (where they are most vulnerable to serious complications) occurs over the weekend.”
The increased death rate was found in both high and low risk operations and in a range of procedures including, chest, heart and abdominal surgery.
The findings, published online in the BMJ, could result in patients demanding admission early in the week leading to waiting list bottlenecks. It recalls fears among motorists 20 to 30 years ago when research showed cars made on a Friday had more faults than those coming off the assembly line on a Monday.
As the weekend approached, assembly line workers became less attentive and more error prone as they anticipated downing tools and enjoying time off. Customers began to demand cars manufactured early in the week.
Currently, hospital wards are mostly staffed by nurses and junior doctors at the weekend with consultants and other senior staff on call at home.
The poorer quality of health care at the weekend has worried officials.
Prof Sir Bruce Keogh, NHS England National Medical Director, said yesterday that the NHS was committed to providing safe care “ co-ordinated round the needs, convenience and choices” of patients and families.
“We have established a forum to develop viable financial and clinical options to help our NHS provide more comprehensive services seven days a week. This forum will report back in the autumn,” he said.
Staffing levels were being examined as part of the Keogh review into death rates at 14 trusts with high mortality rates announced last year, he added.
NHS London calculated in 2011 that over 500 lives a year could be saved in the capital if weekend death rates were brought down to the level during the week.
A poll by the Royal College of Physicians found one in eight senior doctors feared for their patients at weekends. One respondent said: “I often feel relieved on a Monday that nothing catastrophic has happened.”
The College has set up a Future Hospital Commission, chaired by Sir Michael Rawlins, former chair of the National Institute of Clinical Excellence, to consider how hospitals should cope with an ageing population, increasingly complex cases and changes to doctors working patterns.
But critics have challenged the claim that safe care can be delivered seven days a week. Paul Flynn, chair of the British Medical Association’s consultant’s committee , said it was impractical in the face of cutbacks.
Writing in the BMJ earlier this year he said: “It flies in the face of all logic to reward a system that is not using its existing resources to best effect over five days by giving it the opportunity to mismanage them over seven.”
”Many NHS providers are already consulting on [redundancies]. It is inconceivable that they will be able to staff operating theatres and clinics seven days a week.“
Operations: Other dates to avoid
There are some dates in the calendar that the wary NHS patient seeks to avoid. The first Wednesday in August marks the arrival of 6.000 newly qualified doctors, gripping their stethescopes in sweaty hands.
It is known as “Black Wednesday” – the start of the “killing season”. Research shows death rates rise by 6 per cent in August as the new crop of medical graduates takes to the wards for the first time.
More recent studies have highlighted the elevated risks of night and weekend surgery when junior doctors are left in charge and their consultant mentors are in bed or on the golf course.
Sir Bruce Keogh, NHS Medical Director, says the health service must provide care to the same high standard 24 hours a day, seven days a week, and at all times of the year.
But this can only mean more staff or fewer hospitals providing surgery. It makes no sense to spread the existing staff more thinly so they provide a worse service over a longer period.
With the NHS under pressure to deliver £20 billion in savings, hiring more staff is not an option. That leaves closing hospital departments and concentrating the existing staff in fewer specialist units.
The royal medical colleges have been calling for such a change for years. It won’t be comfortable or pretty but it is time for politicians to act.
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