According to an editorial, this study provides support for two of the alternative explanations for the weekend effect, data artefact and case mix. It notes three other recent studies have filled other gaps.
• Aldridge et al examined the work of consultants at weekends and found an increase in mortality at the weekend but, while noting several limitations such as a low response rate among consultants, were unable to show any association between the intensity of consultant input to patient care and mortality.
• Bray et al studied stroke outcomes using a clinical database that overcame many limitations of administrative data and found no weekend increase in mortality but did find complex variation in the use of investigations and treatment, with patients admitted on weekday nights faring worst.
• Meacock et al found that threshold for admitting patients is higher at weekends- such patients getting over this higher weekend threshold are sicker and more likely to die; the weekend effect disappears after appropriate adjustment.
The editorial suggests that collectively, these studies show that at least part of the weekend effect is data artefact and, consistent with evidence that was available when the health secretary made his initial statement, whilst any remaining association between weekend admission and mortality does not seem to be due to hospital medical staffing. It notes that these findings also raise other questions- the reported weaknesses of administrative data cast further doubt on the use of measures such as hospital standardised mortality rate, and and to the extent that a weekend effect does exist, what is the appropriate response? It adds that the available evidence points to a need for improvements in availability of primary care and possibly nurse staffing, but much more research is needed. It poses the question of how, in the face of what is now known, the Department of Health can still insist that doctors in training must accept a new contract to address any weekend effect.