16% more likely to die

I have read with interest today several articles in several papers, which say that people are more likely to die if they are admitted to hospital at the weekend. This follows a lengthy study of a huge amount of NHS data.

Apparently, compared to a Wednesday, 16% more patients die on Sunday, whilst 11% more patients die on a Saturday.  It is important to note that this is for patients who are admitted on those days and were not already in hospital and who die within a month after their admission.  If you are already in hospital on a Sunday you are actually 8% less likely to die compared to if you were already in hospital on Wednesday.

What I find really interesting in all this though is that it has already been decided that there is a simple answer to this obviously complicated problem.  There are insufficient senior doctors in hospitals over the weekend and patients are more likely to die because they do not receive treatment as quickly as they would on other days.  By increasing the number of senior doctors and running hospitals 24/7, death rates will be normalised and won’t differ by the day of the week.

What is missing from this discussion however, is any mention of demand.  Anyone who drives to work will know that demand is not a constant or linear. There is huge variety and fluctuation.  Some days are busier than others but also the type of traffic varies by times of day.

The same is bound to be true of hospital admissions.  People who visit hospitals at weekends will not necessarily be the same as those who visit during the week. 

My guesses are that more people with serious illnesses will go to hospital on Saturday or Sunday.   They know that the service will not be as good as during the week and so their threshold for a visit must be higher.  People are less likely to be at work on the weekend and so have less access to first aid or colleagues’ attention which could lead to increased survival rates during the week.  More people are at home at the weekend and may experience accidents that are less common than the other five days. There may also be less of all types of staff in the hospital who provide key services, porters, nurses and admissions people.  All of these could be contributory factors

I stress that these are all guesses but then I believe so is the assertion that the problem is to do with the number of senior doctors who are available.  The NHS need to take the data and dig deeper until the real reasons for the increase in death rates are understood.