The ‘weekend effect’ in acute medicine: a protocol for a team-based ethnography of weekend care for medical patients in acute hospital settings

Abstract

IntroductionIt is now well-recognised that patients admitted to hospital on weekends are at higher risk of death than those admitted during weekdays. However, the causes of this ‘weekend effect’ are poorly understood. Some contend that there is a deficit of medical staff on weekends resulting in poorer quality care, whereas others find that patients admitted to hospital on weekends are sicker and therefore at higher risk of adverse outcomes. Clarifying the causal pathway is clearly important in order to identify effective solutions. In this article we describe an ethnographic approach to evaluating the organisation and delivery of medical care on weekends compared with weekdays, with a specific focus on the role of medical staff as part of National Health Service England’s plan to implement 7-day services.Methods and analysisWe will conduct an ethnographic study of 20 acute hospitals in England between April 2016 and March 2018 as part of the High-intensity Specialist-Led Acute Care project (www.hislac.org). Data will be collected through observations and shadowing, and interviews with staff, in 10 hospitals with higher intensity specialist (consultant) staffing on weekends and 10 with lower intensity specialist staffing. Interviews will be conducted with up to 20 patients sampled from two high-intensity and two low-intensity sites. We will coordinate, compare and contrast observations across our team of ethnographers. Analysis will be both in-depth and cross-cutting, exploring specific features within individual sites and making comparisons between them. We outline how data collection and analysis will be facilitated and organised.Ethics and disseminationThe project has received ethics approval from the South West Wales Research Ethics Committee: Reference 13/WA/0372. Informed consent will be obtained for all interview participants. The findings will be disseminated through peer-reviewed publications in high-quality journals and at national and international conferences.

Trends and Weekly Cycles in a Large Swiss Emergency Centre: A 10 Year Period at the University Hospital of Bern

“…In previous research projects described that hospital admission depending of the weekday was associated with increased mortality and greater lengths of stay. Some studies attribute worse weekend outcomes, referred to as the “weekend effect” to lower hospital staffing levels and service availability [ 15 ].…”

Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays

“…This protocol describes using retrospective case record review to determine whether the quality of care received by patients admitted to hospital as emergencies, varies between weekdays and weekends. The study will contribute to our understanding of the ‘weekend effect’ and the implementation of 7-day services policy by integrating data on error rates and AEs with parallel workstreams on specialist staffing, 4 a systematic review and framework synthesis of the weekend effect, 12 ethnographic evaluations 13 and Bayesian health economics modelling. 14 …”

“…The elicitation of these prior probabilities will be informed by data from the HiSLAC mixed-methods systematic review of the weekend effect 12 and information derived from the parallel HiSLAC ethnographic study of the 20 hospitals. 13 The methodology for elicitation of this ‘prior’ and for the updating process has been described elsewhere. 14 To calculate the cost utility/benefit of the 7-day services policy of increasing specialist intensity, three further parameters are needed: (a) the error rates must be converted into AE rates and hence into Quality-Adjusted Life Years (QALYs) using the method of Yao et al 27 and Lilford et al 28 ; (b) potential cost savings from (any) reduction in AEs will be calculated, again according to Yao et al 27 and (c) the cost of the intervention itself will be calculated building on Meacock et al .…”

“…We describe here a protocol for comparing quality of care given to patients admitted as emergencies to 20 hospital Trusts at weekends and on weekdays during two epochs, representing periods before (2012–2013) and during (2016–2017) the implementation of NHS England’s 7-day services standards. The outputs from this protocol will be integrated with parallel HiSLAC research workstreams in specialist intensity, 4 a systematic review and framework synthesis, 12 ethnography 13 and health economics. 14 …”

La urgencia bajo la lupa: una revisión de la producción científica sobre servicios de emergencia en hospitales desde la etnografía

“…Another factor that affects care is the so-called "weekend effect", indicating greater risk of dying on weekend shifts compared to weekdays 56 .…”