The Ethical Imperative to Move to a Seven-Day Care Model

Abstract

Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.

What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units

“…Seven-day provision of consistent, high-quality urgent and emergency care settings is an international research and policy priority 1–6. This is motivated by 15 years of attention placed on the enigmatic ‘weekend effect’ and other temporal variations,7 scrutinising mortality and other outcomes for those admitted at the weekend compared with during the week 5 8–14.…”

Temporal variations in quality of acute stroke care and outcomes in London hyperacute stroke units: a mixed-methods study

“…It is now recognised that temporal variation results, at least in part, from delivery models of care and the cultural values of the health-care sector, enshrined in everyday practice, funding models, staffing practices and wider policies. 29 Recent research, such as the High-Intensity Specialist-Led Acute Care study, 30,31 have taken this approach to examine the intensity of specialist-led care in emergency medical admissions, focusing particularly on the organisation and delivery of care, and medical staffing. 30,31 In the case of urgent stroke care, recent studies have shown that temporal variation in mortality is now decreasing, 32,33 including in London's hyperacute stroke unit (HASU) model.…”

“…Seven-day provision of consistent, high-quality, urgent and emergency care settings is an international research and policy priority. 9,11,29,61,78,79 This has motivated 15 years of attention on the 'weekend effect' and other temporal variations, 22 scrutinising mortality and other outcomes for those admitted at the weekend compared with those admitted during the week. 6,7,9,31,[80][81][82][83] Varying features that may explain differential outcomes include staffing levels 31 and patient mix, 25 leading to widespread interest in studying weekend organisational features.…”

After‐hours emergency department care: Does time or day of arrival affect survival?

“…Although EDs operate much closer to a 24/7 model of care, 12,13 they exist within the context of the broader hospital which typically does not. 14 Patient case-mix (i.e. sociodemographic or case-mix characteristics) and hospital staffing differences between within-and after-hours periods are of significant interest when considering any potential differences in outcome.…”

“…Investigations of outcomes for after‐hours healthcare delivery have typically focused on inpatient admissions. Although EDs operate much closer to a 24/7 model of care, 12,13 they exist within the context of the broader hospital which typically does not 14 . Patient case‐mix (i.e.…”