Manchester Centre for Health Economics, University of Manchester, Manchester, UK.
Emerg Med J. 2018 Feb;35(2):108-113. doi: 10.1136/emermed-2017-206740. Epub 2017 Nov 8.
Patients admitted to hospital in an emergency at weekends have been found to experience higher mortality rates than those admitted during the week. The National Health Service (NHS) in England has introduced four priority clinical standards for emergency hospital care with the objective of reducing deaths associated with this 'weekend effect'. This study aimed to determine whether adoption of these clinical standards is associated with the extent to which weekend mortality is elevated.
We used publicly available data on performance against the four priority clinical standards in 2015 and estimates of Trusts' weekend effects between 2013/2014 and 2015/2016 for 123 NHS Trusts in England. We examined whether adoption of the priority clinical standards was associated with the extent to which weekend mortality was elevated, and changes over a 3 year period in the extent to which mortality was elevated.
Levels of achievement of two of the four clinical standards (ongoing review and access to diagnostic services) had small positive associations with the magnitude of the weekend effect in 2015/2016. Levels of achievement of the remaining two standards (time to first consultant review and access to consultant directed interventions) had small negative associations with the magnitude of the weekend effect in 2015/2016. No association was statistically significant. The same pattern was observed in the associations between achievement of the standards and changes in the magnitudes of the weekend effect between 2013/2014 and 2015/2016.
We found no association between Trusts' performance against any of the four standards and the current magnitude of their weekend effects, or the change in their weekend effects over the past 3 years. These findings cast doubt on whether adoption of seven day clinical standards in the delivery of emergency hospital services will be successful in reducing the weekend effect.
周末住院的患者比一周内住院的患者死亡率更高。英格兰国民保健制度（NHS）为急诊住院治疗制定了四项优先临床标准，目的是降低与这种“周末效应”相关的死亡。本研究旨在确定采用这些临床标准是否与周末死亡率升高的程度有关。
我们使用了 2015 年关于四项优先临床标准的绩效的公开数据以及 2013/2014 年至 2015/2016 年期间 123 家英格兰 NHS 信托基金周末效应的估计值。我们检查了优先临床标准的采用是否与周末死亡率升高的程度有关，以及在 3 年期间死亡率升高的程度变化。
四项临床标准中的两项（持续审查和获得诊断服务）的实现水平与 2015/2016 年周末效应的幅度有小的正相关。其余两项标准（首次顾问审查的时间和获得顾问指导的干预措施）的实现水平与 2015/2016 年周末效应的幅度有小的负相关。没有统计学意义上的关联。在 2013/2014 年至 2015/2016 年期间，标准的实现与周末效应幅度变化之间的关联也存在相同的模式。
我们没有发现信托基金在任何四项标准方面的表现与当前周末效应的幅度，或过去 3 年周末效应的变化之间存在关联。这些发现对在提供急诊医院服务时采用七天临床标准是否能成功降低周末效应表示怀疑。
