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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

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
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

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.

emergency department, health policy, health services research, measurement/epidemiology, medical error, quality improvement
2044-5415
Bion, Julian
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Aldridge, Cassie
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Girling, Alan J.
c1563628-4d38-4e5d-82e6-0c4d33ce761d
Rudge, Gavin
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Sun, Jianxia
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Tarrant, Carolyn
fdf68277-b4a1-472a-a823-6d9018388254
Sutton, Elizabeth
c35d71f1-05ec-413c-a6c8-f2d525c1d131
Willars, Janet
db490416-a66f-49e5-ab09-2c787c55194b
Beet, Chris
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Boyal, Amunpreet
52349e3f-efb1-4f29-b620-95e23379acc2
Rees, Peter
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Roseveare, Chris
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Temple, Mark
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Watson, Samuel Ian
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Chen, Yen Fu
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Clancy, Mike
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Rowan, Louise
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Lord, Joanne
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Mannion, Russell
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Hofer, Timothy
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Lilford, Richard
deba99d6-e888-4f32-a162-8d36da790ffe
Bion, Julian
57c7fc1a-5a87-48d1-b4dd-748a9d8c76e7
Aldridge, Cassie
5b79121f-8923-4220-9e00-d1105e1c3649
Girling, Alan J.
c1563628-4d38-4e5d-82e6-0c4d33ce761d
Rudge, Gavin
2e2e73c7-f899-4677-bb8f-a30d3aeb29f3
Sun, Jianxia
4414a316-9718-4173-8f63-e3ee2b99cdc7
Tarrant, Carolyn
fdf68277-b4a1-472a-a823-6d9018388254
Sutton, Elizabeth
c35d71f1-05ec-413c-a6c8-f2d525c1d131
Willars, Janet
db490416-a66f-49e5-ab09-2c787c55194b
Beet, Chris
28311a08-f3cc-4ae0-aa68-fb91d78c0d9e
Boyal, Amunpreet
52349e3f-efb1-4f29-b620-95e23379acc2
Rees, Peter
551cdeec-0dca-4ebc-b2f6-423125c59042
Roseveare, Chris
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Temple, Mark
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Watson, Samuel Ian
99f8786b-54fa-401e-83ff-70ee660e31d0
Chen, Yen Fu
2cdacb26-d432-4ba5-acfd-e0d88879a7d9
Clancy, Mike
3d19521d-8495-42d5-b346-b7b89401d70e
Rowan, Louise
6664f3ac-c544-409b-8c91-7a0feaf2f041
Lord, Joanne
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Mannion, Russell
f9c3781d-2cf3-424a-8580-9b9da8cafcaa
Hofer, Timothy
835fe637-dfe3-4204-9e02-e43d588090e3
Lilford, Richard
deba99d6-e888-4f32-a162-8d36da790ffe

Bion, Julian, Aldridge, 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 and Lilford, Richard (2020) 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 Quality and Safety. (doi:10.1136/bmjqs-2020-011165).

Record type: Article

Abstract

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.

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More information

Accepted/In Press date: 11 October 2020
e-pub ahead of print date: 28 October 2020
Additional Information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Keywords: emergency department, health policy, health services research, measurement/epidemiology, medical error, quality improvement

Identifiers

Local EPrints ID: 445796
URI: http://eprints.soton.ac.uk/id/eprint/445796
ISSN: 2044-5415
PURE UUID: 0d1f93f3-791c-40ff-b91f-76df58d296d3
ORCID for Joanne Lord: ORCID iD orcid.org/0000-0003-1086-1624

Catalogue record

Date deposited: 07 Jan 2021 17:34
Last modified: 28 Apr 2022 02:13

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Contributors

Author: Julian Bion
Author: Cassie Aldridge
Author: Alan J. Girling
Author: Gavin Rudge
Author: Jianxia Sun
Author: Carolyn Tarrant
Author: Elizabeth Sutton
Author: Janet Willars
Author: Chris Beet
Author: Amunpreet Boyal
Author: Peter Rees
Author: Chris Roseveare
Author: Mark Temple
Author: Samuel Ian Watson
Author: Yen Fu Chen
Author: Mike Clancy
Author: Louise Rowan
Author: Joanne Lord ORCID iD
Author: Russell Mannion
Author: Timothy Hofer
Author: Richard Lilford

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