'Weekend effect' does not exist for patients at major trauma centres - study


Patients treated at specialist units at weekends for major trauma are just as likely to survive as those admitted on week days, a study found.

Research led by Oxford University found no signs of higher death rates, or the "weekend effect", for patients brought to major trauma centres (MTCs) on Saturdays or Sundays.

The study hunted for evidence that people arriving at hospital at the weekends had worse outcomes than those admitted on week days, examining data from the 22 MTCs in England that care for just adults or both adults and children.

But it found outcomes were comparable, irrespective of the day patients were brought in.

Dr David Metcalfe, who led the research, said the findings suggested it is "worthwhile" to offer the same level of service for seriously injured patients at weekends.

Treatment for people who have suffered major trauma such as road crashes, severe assault or gun and knife wounds was reorganised in England and Wales in 2012, focusing resources into a number of small, specialised hospitals.

Consultants are on hand every day of the week, and doctors also have round-the-clock access to operating theatres, CT scans and other treatment facilities.

Previous studies have suggested that patients admitted to NHS hospitals at weekends have worse outcomes than those brought in during the week.

Figures from NHS Digital from 137 hospitals show patients admitted to hospitals at weekends are 15% more likely to die within a month, while those discharged on a Sunday have 40% more chance of being rushed back to A&E within 30 days than if they left hospital during the week.

But the researchers found no discernible difference in the proportions of patients that died or made a good recovery based on when they arrived at specialist trauma units.

The study examined the results of 49,070 patients treated for severe injuries at the MTCs since each unit was set up.

Some 63.9% of all major trauma patients admitted on week days made a good recovery, compared with 64.1% on weekends, while 63.9% made good recoveries after being admitted on week nights, almost the same as the 63.5% brought in on weekend nights.

Death rates were similarly comparable.

Of the patients admitted on week days, 8.5% died, against 8.4% who died after admission on weekend days. Of those brought to the centres on week nights, 8.4% died, against 7.9% admitted on weekend nights.

The researchers concluded that while the idea of the "weekend effect" has become largely "ubiquitous", it is "undetectable in an all-hours consultant-led major trauma service".

Dr Metcalfe said: "We thought if we look and find that still patients have worse outcomes, even despite that reorganisation of resources, then that would suggest that worse outcomes at the weekends aren't actually related to how the service is organised.

"But we found that the 'weekend effect' doesn't appear to exist for severely injured patients in major trauma centres."

Data for major trauma outcomes before the MTCs were set up was not collected in the same way and so cannot be compared, Dr Metcalfe said.

However, he added: "It might be surmised that reorganising services in that way could be an answer to ensuring that patients get the same care regardless of when they come to hospital.

"It is an indicator, I think, in the context of other studies that have been published recently, that it is a worthwhile exercise to try and provide the same level of service for patients who have emergency conditions at the weekend."

A National Audit Office (NAO) report in 2010 estimated there are at least 20,000 cases of major trauma each year in England, resulting in 5,400 deaths.