Junior doctor admitting practices may be behind ‘weekend effect’

New research by the University of Cambridge has linked the ‘weekend effect’ of increased hospital mortality to junior doctors admitting a lower proportion of healthy patients at the weekend compared to weekdays.

The 'weekend effect' of increased hospital mortality has been well documented, including a 2015 study linking this to 11,000 extra UK deaths annually, which led to controversial contract changes for junior doctors.

But, despite this, the questions remains as to whether hospitals really are less safe on weekends or whether other factors lead to a comparison-skewing weekday reduction of the risk of mortality.

The study, based on nearly 425,000 emergency department attendances over seven years at Addenbrooke’s Hospital in Cambridge, confirms the weekend effect. This appears to be because junior doctors are more likely to admit patients with lower mortality risk during the week. The research found that junior doctors based in the emergency department admitted less-sick patients at half the rate at weekends compared to weekdays, diluting the risk pool of weekday mortality and contributing to the weekend effect.

In contrast, the admitting patterns of senior doctors was the same on weekends and weekdays, and the data did not provide evidence of a weekend effect among patients admitted by senior doctors.

Stefan Scholtes, who co-authored the research, said: “There has been previous research on how physician-level factors influence patient care, but our study instead focuses specifically on how seniority affects admitting patterns and in turn how this relates to the weekend effect. It’s clear that the admitting patterns of junior doctors changes at the weekend.”