Research finds that patients are at a higher risk of death if admitted to hospital out of hours
Recent research has suggested that patients admitted to hospital over the weekend are more likely to die than those admitted from Monday to Friday (). The author of the study, Dr Foster, found that two of the key factors that could contribute to higher mortality rates outside of normal working hours are:· reduced specialist in-hospital services being available out-of-hours, particularly diagnostic investigations such as MRI scans; and · different out-of-hours staffing levels (for example, out-of-hours consultants are normally on call rather than on site and immediately available in the hospital) recently assisted the family of a young man admitted to hospital with chest pain on a Monday afternoon, who tragically died the next morning. He had suffered an undiagnosed dissection of his aorta. The patient was initially assessed by an F2, was assessed and admitted by a Specialist Registrar and was later seen by an F1 - but he was never seen by a Consultant. Although there was a Consultant on-call, overnight, the junior doctors did not recognise that a more senior opinion was required. Also of note, a chest x-ray taken in the early evening was reviewed by the junior doctor but not by a radiologist until the following morning (in fact after the patient had died). The Inquest heard that a more experienced, senior doctor would have recognised the warning signs and symptoms, made the correct diagnosis and that the patient's death would probably have been avoided. The Inquest further heard that whereas x-rays would normally be reviewed by a radiologist within 2 or 3 hours, x-rays taken late in the afternoon or during the evening would not routinely be reviewed by a radiologist until the following morning. At the conclusion of the Inquest, the hospital agreed to conduct a detailed review and take specific steps in order to improve out-of-hours patient care. These included reinforcing upon junior doctors the importance of seeking advice from senior doctors; considering (amongst other steps) the extension of radiology cover round the clock; and moving to greater involvement of Consultants. These are difficult issues and require the careful balancing of resources. The pressures on hospitals are likely to become greater in the current economic climate but it is important that steps are taken to ensure that, as far as possible, there is a high level of patient care around the clock, seven days a week. Following the Inquest, secured settlement of the family's medical negligence claim for an undisclosed sum.