title: A retrospective study of seven-day consultant working: reductions in mortality and length of stay.
abstract: Weekend admission is associated with higher in-hospital mortality than weekday admission. Whether providing enhanced weekend staffing for acute medical inpatient services reduces mortality or length of stay is unknown.
  
  
  METHODS
  This paper describes a retrospective analysis of in-hospital mortality and length of stay before and after introduction of an enhanced, consultant-led weekend service in acute medicine in November 2012. In-hospital mortality was compared for matching admission calendar months before and after introduction of the new service, adjusted for case volume. Length of stay and 30-day postdischarge mortality were also compared; illness severity of patients admitted was assessed by cross-sectional acuity audits.
  
  
  RESULTS
  Admission numbers increased from 6,304 (November 2011-July 2012) to 7,382 (November 2012-July 2013), with no change in acuity score in elderly medical patients but a small fall in younger patients. At the same time, however, a 57% increase in early-warning score triggered calls was seen in 2013 (410 calls vs 262 calls in 2012; p<0.01). Seven-day consultant working was associated with a reduction in in-hospital mortality from 11.4% to 8.8% (p<0.001). Mortality within 30 days of discharge fell from 2.4% to 2.0% (p=0.12). Length of stay fell by 1.9 days (95% CI 1.1-2.7; p=0.004) for elderly medicine wards and by 1.7 days (95% CI 0.8-2.6; p=0.008) for medical wards. Weekend discharges increased from general medical wards (from 13.6% to 18.8%, p<0.001) but did not increase from elderly medicine wards.
  
  
  CONCLUSIONS
  Introduction of an enhanced, consultant-led model of working at weekends was associated with reduced in-hospital and 30-day post discharge mortality rates as well as reduced length of stay. These results require confirmation in rigorously designed prospective studies.
authors.affiliation: D Bowen-Jones, Wirral University Teaching Hospital, Arrowe Park Hospital, Wirral, CH49 5PE, UK. Email david.bowen-jones@nhs.net.
authors.forename: K S
authors.initials: KS
authors.lastname: Leong
authors.forename: A
authors.initials: A
authors.lastname: Titman
authors.forename: M
authors.initials: M
authors.lastname: Brown
authors.forename: R
authors.initials: R
authors.lastname: Powell
authors.forename: E
authors.initials: E
authors.lastname: Moore
authors.forename: D
authors.initials: D
authors.lastname: Bowen-Jones
mesh_terms: D039602:After-Hours Care; D000368:Aged; D003430:Cross-Sectional Studies; D017052:Hospital Mortality / Q000639:trends*; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends*; D017146:Models, Organizational; D062072:Patient Acuity; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends*; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000458:organization & administration*; D012189:Retrospective Studies
keywords: 30 day mortality; in-hospital; length of stay; mortality