TY  - JOUR
JF  - BMC Health Services Research
A1  - Gan, H-W
A1  - Wong, DJN
A1  - Dean, BJF
A1  - Hall, AS
KW  - Science & Technology
KW  -  Life Sciences & Biomedicine
KW  -  Health Care Sciences & Services
KW  -  Hospital mortality
KW  -  Length of stay
KW  -  Weekend
KW  -  Emergency care
KW  -  Health services research
KW  -  MORTALITY
KW  -  ADMISSIONS
N2  - Background:
The cause of adverse weekend clinical outcomes remains unknown. In 2013, the ?NHS Services, Seven Days a Week? project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS.

Methods:
Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained from national Hospital Episode Statistics and A&E datasets across the English NHS, excluding mental and community health trusts. Trust annual reports were analysed to determine the presence of any seven-day service reorganisation in 2013?2014. Funnel plots were generated to compare institutional performance and a difference in differences analysis was performed to determine the impact of seven-day changes on clinical outcomes between 2013 and 2014, 2014?2015 and 2015?2016. Data was summarised as mean (SD).

Results:
Of 159 NHS trusts, 79 (49.7%) instituted seven-day changes in 2013?2014. Crude mortality rates, A&E admission rates and mean LOS remained relatively stable between 2013 and 2016, whilst A&E four-hour breach rates nearly doubled from 5.3 to 9.7%. From 2013 to 2014 to 2014?2015 and 2015?2016, there were no significant differences in the change in crude mortality (2014?2015 p = 0.8, 2015?2016 p = 0.9), SHMI (2014?2015 p = 0.5, 2015?2016 p = 0.5), mean LOS (2014?2015 p = 0.5, 2015?2016 p = 0.4), A&E admission (2014?2015 p = 0.6, 2015?2016 p = 1.0) or four-hour breach rates (2014?2015 p = 0.06, 2015?2016 p = 0.6) between trusts that had implemented seven-day changes compared to those which had not.

Conclusions:
Adverse weekend clinical outcomes may not be ameliorated by large scale reorganisations aimed at improving access to health services across the week. Such changes may negatively impact care quality without additional financial investment, as demonstrated by worsening of some outcomes. Detailed prospective research is required to determine whether such reallocation of finite resources is clinically effective.
ID  - discovery1571528
PB  - BIOMED CENTRAL LTD
UR  - http://dx.doi.org/10.1186/s12913-017-2505-8
SN  - 1472-6963
N1  - Open Access: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
TI  - Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the "NHS Services, Seven Days a Week" project 2013-2016
Y1  - 2017/08/10/
AV  - public
VL  - 17
EP  - 10
ER  -