Dr Foster Guide Highlights Some Troubling Statistics
There is no good time to get ill or suffer injury, but it is clear there is a bad time, namely weekends. This years’ ‘Dr. Foster Hospital Guide’ has published some very troubling statistics, where they measured a ten percent blip in mortality rates from Friday to Sunday over 147 hospital trusts and higher than expected general mortality rates in more than 25% of trusts. It is clear that many of the deaths could have been avoided if full weekday services such as diagnostics, had been in play at weekends.
The Dr. Foster Hospital Guide, which has come out every year since 2001 analysed data on mortality rates in four categories; in hospital, in hospital and inside a month from discharge, deaths connected with relatively low risk conditions and those after surgical procedures. Forty two of the 147 trusts had higher than expected mortality rates in at least one of the categories, and at least 22 of these showed up in two of the categories while two were high in three.
Though the Dr. Foster Hospital Guide specifically provides healthcare information for hospitals in the United Kingdom, the potential issues of both access to imaging procedures as well as limited availability of senior staff during weekends and late night hours is not limited to the UK.
Here is an anecdote from Arrowe Park hospital that illustrates at least part of the problem. An elderly female patient had undergone minor surgery on a Friday and declined drastically toward Sunday afternoon when a Junior doctor actually informed her son of her imminent death. The son had spoken with the consultant surgeon after the operation and both were pleased with the outcomes. Yet 48 hours later she was distressed, ranting and moaning. When the son insisted on speaking with his mothers’ consultant he was told that he ‘doesn’t work on Sundays’ and the junior doctor was the official deputy. A courageous nurse stepped in to support the son’s need for better information.
Faced with an immovable and insistent relative the junior doctor relented and admitted the consultant was on call and duly called him. The said consultant came in time to diagnose quickly that the patients daily medication routine had not been restarted following her operation and she came ‘back to life’ within 24 hours of the pills being taken. However had her son not been so insistent his mother would have been part of the ubiquitous weekend death toll.
As in this case, the weekend mortality rate spike is an effect with multiple causes; poor liaison by the consultant, inadequate notes with the patient, an indifferent and or inexperienced junior all combined in this case for a difficult interaction but fortunately not a fatality. It could esaily have been otherwise. The Pareto or 80/20 rule probably applies to this multi cause problem. With 80% of the effects deriving from just 20% of the possible causes. Lack of consultant access at weekends is probably part of that 20%. Dr fosters are working with the Department of Health to diagnose all of the causes and provide targetted solutions to each one of them.