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Research exposes flaws in ‘weekend effect’ argument

Quality of care varies across the whole week and not exclusively at weekends

Mark Gould

Tuesday, 19 July 2016

Analysis of patterns of stroke care across a whole week reveals that the often repeated simplistic criticism that the "weekend effect" has a deleterious effect on care should be seriously challenged.

Writing in The Lancet,* researcher by Dr Ben Bray, public health registrar and research director of the Royal College of Physician’s Sentinel Stroke National Audit Programme (SSNAP) set out to describe and quantify the magnitude and pattern of variation in healthcare quality across the whole week, not just between weekdays and weekends.

He used data from the SSNAP because it is known that rapid access to appropriate care, such as stroke unit care and thrombolysis, improves outcomes and saves lives.  Instead of simply comparing weekends and weekdays, analysis broke data down into four-hour time blocks across the whole week. The team then looked at how acute stroke care quality varied across all these time blocks, after adjusting for differences in patient characteristics.

The research found that getting a rapid brain scan depended far more on time of admission than day of the week, with patients more likely to get a brain scan within one hour of admission in the morning than in the afternoon or overnight.

By contrast, access to a stroke unit was not just quicker during the daytime but also got quicker across the week, with Mondays being the slowest and Fridays the fastest. Similarly, patients admitted on Fridays and Thursdays had to wait the longest for assessments by a physiotherapist, occupational therapist or speech and language therapist. And they found that there were no differences between survival rates on weekends and weekdays, but slightly poorer survival for patients admitted overnight.

Dr Bray said: "What we found suggested that, at least for stroke care, the idea of the weekend effect was a major simplification of patterns in care quality that in fact extended across the whole week."

He says the results suggest that the discussion surrounding the weekend effect is "really missing the far bigger picture about how care quality varies across the week".

"Different aspects of care show different patterns of variation, suggesting they have different underlying reasons – perhaps for example, a relative lack of weekend therapy staffing. Alternatively, social services might be less able to facilitate weekend discharges, resulting in stroke units that are too full to take new admissions by the time Monday morning arrives. "

* Bray BD, et al. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke.  The Lancet, Volume 388, No. 10040, p170–177, 9 July 2016. DOI:10.1016/S0140-6736(16)30443-3care.

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