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Title: Quality and safety of in-hospital care for acute medical patients at weekends: a qualitative study.
Authors: Sutton, E
Bion, J
Aldridge, C
Boyal, A
Willars, J
Tarrant, C
First Published: 29-Dec-2018
Publisher: BMC (part of Springer Nature)
Citation: BMC Health Services Research, 2018, 18, Article number: 1015
Abstract: BACKGROUND: The increased mortality risk associated with weekend admission to hospital (the 'weekend effect') has been reported across many health systems. More recently research has focused on causal mechanisms. Variations in the organisation and delivery of in-hospital care between weekends and weekdays have been identified, but this is not always to the detriment of weekend admissions, and the impact on mortality is uncertain. The insights of frontline staff and patients have been neglected. This article reports a qualitative study of patients and clinicians, to explore their views on quality and safety of care at weekends. METHODS: We conducted focus groups and interviews with clinicians and patients with experience of acute medical care, recruited from three UK hospital Trusts. We analysed the data using a thematic analysis approach, aided by the use of NVivo, to explore quality and safety of care at weekends. RESULTS: We held four focus groups and completed six in-depth interviews, with 19 clinicians and 12 patients. Four threats to quality and safety were identified as being more prominent at weekends, relating to i) the rescue and stabilisation of sick patients; ii) monitoring and responding to deterioration; iii) timely accurate management of the therapeutic pathway; iv) errors of omission and commission. CONCLUSIONS: At weekends patients and staff are well aware of suboptimal staffing numbers, skill mix and access to resources at weekends, and identify that emergency admissions are prioritised over those already hospitalised. The consequences in terms of quality and safety and patient experience of care are undesirable. Our findings suggest the value of focusing on care processes and systems resilience over the weekends, and how these can be better supported, even in the limited resource environment that exists in many hospitals at weekends.
DOI Link: 10.1186/s12913-018-3833-z
eISSN: 1472-6963
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Description: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Additional files at online version: Additional file 1: HiSLAC v2 Focus group- topic guide - clinicians. Topic guide used in clinician interviews and focus groups. (DOCX 25 kb) Additional file 2: HiSLAC focus group - topic guide -patients. Topic guide used in patient interviews and focus groups. (DOC 61 kb) Additional file 3: The weekend effect FGs round 2 clinicians 251016. Supplementary material for clinician interviews and focus groups. (PDF 485 kb) Additional file 4: The weekend effect FGs round 2 patients 181016. Supplementary material for clinician interviews and focus groups. (PDF 401 kb) Additional file 5: Descriptive coding frame used for initial coding of data. (DOCX 40 kb)
Appears in Collections:Published Articles, Dept. of Health Sciences

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