​The higher risk of death in patients admitted to the hospital on weekends, the so-called weekend effect, may have little to do with weekend staffing levels, according to a study published in the July 2017 issue of The Lancet. Instead, the authors said, the weekend effect may arise from patient-level differences at admission. The authors analyzed 30-day mortality rates for emergency department admissions at four hospitals in a large United Kingdom health system between January 1, 2006, and December 31, 2014. More patients died within 30 days of being admitted over the weekend (5.1%) than those who were admitted during the week (4.7%). Adjusting for 15 common tests that predict mortality explained 33% and 52% of the excess mortality associated with emergency admission on Saturdays and Sundays, respectively, compared with Wednesdays the authors said. Moreover, this adjustment explained 87% of the excess mortality related to admissions on national holidays. Because holidays and weekends tend to require similar staffing levels, the authors said, it "seems unlikely" that staffing levels alone are causing the weekend effect. The excess mortality rate that remained after adjustment occurred primarily among patients admitted on Saturday and Sunday between 11 a.m. and 3 p.m. The authors suggested a few potential reasons for the discrepancies; for instance, patients may delay visiting a hospital overnight on a Friday or Saturday, and access to more appropriate care for frail individuals may be unavailable on weekends. This leads to patients presenting on weekend afternoons with an already greater risk of mortality. The problem may not be preventable through seven-day hospital services, the authors concluded. "By contrast," the authors said, "the unintended consequence of patients delaying presenting to hospital because of fears of worse care at the weekends poses a clear, avoidable danger."

HRC Recommends: The reasons for differences in care quality in hospitals on weekdays and weekends must be properly understood so that solutions can be appropriately targeted. Risk managers' awareness and support of quality-of-care data collection and reporting are critical to ensure that the goals of quality improvement, patient safety, and risk management are congruent. The organization should take an integrated approach to ensure that quality-of-care data are used to address areas of weak performance and to develop strategies to improve.