Friday, 3 February 2012

Never, never on a Sunday...

We can have some fun with numbers with this one:

People have a ‘significantly’ higher risk of dying if they are admitted to hospital at weekends, new evidence reveals. Patients are 16 per cent more likely to die if they are admitted on a Sunday than a Wednesday, and 11 per cent more likely to die if they are admitted on a Saturday...

The analysis covered all planned and emergency admissions – more than 14.2million – to hospitals in England during 2009/10. It looked at 180,000 patient deaths within 30days of being admitted.


It's not clear if they made the obvious adjustment to the figures: "Another factor could be that seriously ill patients are more likely to be admitted on weekends. If they were less ill, they would have had their admissions postponed until a weekday.", and we aren't told how much lower admissions are on a weekend, so we'll have to work with what we've got.

a) 180,000 deaths out of 14.2 million admissions = 1.27% chance of dying.

b) Assuming same number of admissions every day (for lack of anything better), that can be split up into:
Mon - Fri = 1.22% chance of dying.
Sat - Sun = 1.38% chance of dying.
Check: (5 x 1.22) + (2 x 1.39) = 8.88, 8.88 ÷ 7 = 1.27.
Check: 1.22% + (13.5% x 1.22%) = 1.38%.

c) So your additional chance of dying if you are admitted on a weekend is only 0.17%.

Then there's the question of what-is-to-be-done?

Reduced staffing, fewer senior doctors on duty and poor access to diagnostic tests on weekends could have an effect, said researchers... Health secretary Andrew Lansley has said more could be done to increase the number of senior doctors working weekends.

What's the point of that then? It is clearly the case that it is far more expensive getting people to work at the weekend, because they want to be paid overtime etc (call it time and a half for sake of argument). So for a fixed salary budget, a hospital could employ ten fewer people Mon - Fri and seventeen extra people Sat - Sun*. There would be a modest reduction in deaths at weekends, but this would always be lower than the additional deaths during the week, so there'd be a net increase in deaths, end of discussion. So the answer is, just keep muddling along as best they can.

* Check: 10 people x 5 weekdays = 50 days' normal pay. 50 days normal pay ÷ 1.5 = 33.3 days' overtime pay. 33.3 ÷ 2 = 16.7, round it up to 17.

10 comments:

View from the Solent said...

c) So your additional chance of dying if you are admitted on a weekend is only 0.17%.

Sorry Mark, error in your thinking.
Using your figures it would be (1.38-1.21)/1.21 x 100 % as the 'extra' risk.

Mark Wadsworth said...

VFTS, you're doing a diagonal comparison so beloved of TPTB.

They always say e.g. "Drinking wine doubles the risk of contracting XYZ disease" but downplay the fact that the normal risk of contracting XYZ is 0.01%, so even if you drink wine, the risk only goes up to 0.02%, i.e. "not very much and hardly worth worrying about".

The point is, assuming 10,000 patients admitted per day, 12 of those admitted Mon-Fri will die; and 14 of those admitted Sat-Sun will die (rounding 12.2 people down to 12 and rounding 13.8 people up to 14).

i.e. of the 14 people admitted Sat-Sun who die, 12 would have died anyway, it's only the extra 2 which matter, that's the real additional risk. Relative or even absolute risk is nigh irrelevant for decision making purposes.

hovis said...

This of course is all predicated on the idea that going to hospital will in fact save the nominal person's life, which of course could be a fiction in many cases - they'll die no matter what...

Bayard said...

"The analysis covered all planned and emergency admissions – more than 14.2million – to hospitals in England during 2009/10. It looked at 180,000 patient deaths within 30days of being admitted."

Therein lies the answer: something, anything had to be found to justify the cost of all this work.

Anonymous said...

Cheapest way would be to kill a few more in the week to even the slight discrepancy up

Anonymous said...

"So for a fixed salary budget, a hospital could employ"

Apologies but, as I am markedly similar to a much loved fictional character in that I too am "a bear of little brane" I haven't been able to prove to myself that what appears to be a simple solution to weekend staffing shortfall might be cured by the hospital adopting a tactic used in other "industries" where people employed to work a nominal 40 hour week, and when the business works every day (such as say an airline) they issue contracts which state at the outset that "as an employee" your working week will run for 5 days, which might be monday to friday - or saturday to wednesday or wednesday to sunday" ... it does seem to work for the airlines, I haven't noted a "your plane is less likely to actually fly on a saturday or sunday" phenomenon ...

Mark Wadsworth said...

Hovis, MrC has a cunning response to that.

B, they were only rummaging through a database, I'm sure it won't have cost much and the result is always relevant, even if it turns out "things are OK, let's keep going".

Anon 12.57, because that is more expensive.

There are some people happy to work unsociable hours for a premium and others who aren't. So the employer pays the first lot time-and-a-half and the other lot normal rates.

If everybody has to sign up for random unsociable hours, then everybody will demand time-and-a-half for all hours worked to cover the risk and inconvenience of having different shifts imposed on them, hence you add hugely to your wages bill.

Bruce said...

In my personal experience, actually more likely to go to the hospital at the weekend for non life threatening ailments. "Do you think My Little Johnny's ankle is broken or or just a bad sprained?" type visits because GPs are all on the golf course.

Anonymous said...

I would have assumed the increase in mortality rates over the weekend could be explained by booze and drug-fuelled random violence on a Friday & Saturday night?

Still MW, to nick your phrase; they save lives, give them money!

SBC

Mark Wadsworth said...

B, SBC, I think those two effects cancel each other out, don't they?