NHS Covid deaths more likely at weekends than on weekdays

The “weekend effect”, in which NHS patients are more likely to die on Saturday or Sunday, has dogged the Covid pandemic, with a study finding 11 per cent more deaths than on weekdays.

The worldwide study of nearly six million deaths from the virus over two years found there were six per cent more globally during weekends, with a daily average of 8,532 deaths compared to 8,083 during the week.

Britain was found to have one of the worst rates, with an extra 24 patients dying on Saturdays and Sundays on average – 239 deaths at weekends compared with 215 on weekdays.

Of the 10 countries with the worst Covid deaths, only Canada, the US and Brazil were found to have worse weekend effect rates than the UK. Only Germany reported significantly fewer average deaths at weekends compared to weekdays.

The figures for Britain are in stark contrast to the Government’s daily dashboard, which shows a substantial drop in deaths at weekends, due to a lack of reporting, followed by a jump at the start of the week.

‘Findings suggest problem is not resolving’

Dr Fizza Manzoor of the University of Toronto in Canada, the study author, said that although there were clearly reporting problems at weekends mortality might also be higher due to decreased productivity, variable hours and uneven staffing

“The ‘weekend effect’ is also likely to be due to shortfalls in clinical staffing, capacity, and experience,” she said. 

“What’s more, our findings suggest that this problem is not resolving despite improved health system performance and awareness over the course of the pandemic.

“Further studies, with detailed clinical data, are needed to investigate the drivers of and causes for the risk of death on weekdays and weekends from Covid-19.”

Experts are divided about whether the “weekend effect” is a real phenomenon. In 2015, a study in the BMJ showed that 11,000 more people die each year after being admitted to hospital over the weekend in Britain compared with other days of the week.

In 2016, research by University College London and Imperial College London found people admitted at weekends fared less well than those who arrived during the week, saying it was clear that care was sub-standard on Saturdays and Sundays and staffing gaps needed to be filled.

An earlier study of 93,000 stroke admissions by Imperial found stroke patients were less likely to get a scan or clot-busting drugs at weekends, when they were also more likely to develop pneumonia.

Patients admitted at weekends ‘may be sicker’

The Government used the findings to push ahead with a “seven-day” NHS to make sure there were enough specialists in at the weekends.

But other researchers have claimed the results are misleading and fail to take into account that patients admitted at weekends may be sicker.

The University of Manchester looked at three million patient records and found that, once severity was taken into account, there was no increased risk during the weekend except for a very small increase during Sunday daytime

The latest study found the increased mortality was particularly large when comparing Sunday to Monday (8,850 vs 7,219 deaths), a 22 per cent difference, and Friday to Monday (9,086 vs 7,219), a 25 per cent difference.

There were also more deaths on Saturdays – 8,850 – compared to Sundays, when the figure stood at 8,07.1

Because healthcare improved during the pandemic as knowledge of the virus improved, researchers also performed a more detailed evaluation comparing the earlier half (March 2020 to March 2021) to the latter half (March 2021 to March 2022).

They found that although weekend deaths did fall, they were still higher than during the week. There were an average 641 additional weekend deaths (7,825 vs 7,184) – eight per cent more – in the first year compared with an average 257 additional weekend deaths (9,239 vs 8,982) – two per cent more – in the second.

Many variables

The research was presented at the European Congress of Clinical Microbiology and Infectious Diseases in Lisbon.

Prof Jacob Moran-Gilad, the programme director, said: “There are many studies that looked at the effects of hospital admissions during weekends and found an increase in overall mortality or death due to specific disease groups.

“Nevertheless, this is surrounded by controversy as many variables could influence such outcomes, such as administrative, eg reporting or registry; behavioural, eg health-seeking behaviour of individuals; and clinical aspects, quality of care, staffing etc.

“Establishing where, when and why such weekend effect does impact patient outcomes is important and could impact public health policy, patient guidance and health infrastructures. Thus further studies taking into account the various methodological difficulties are definitely warranted.”

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