Evidence map›Paper›PMID 31164363›Full record

SynthesisBMJ open2019

Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis.

Yen-Fu Chen, Xavier Armoiry, Caroline Higenbottam, Nicholas Cowley, Rajna Basra, Samuel Ian Watson, Carolyn Tarrant, Amunpreet Boyal, Elizabeth Sutton, Chia-Wei Wu and 4 more

Erratum issuedAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 34 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Yen-Fu ChenDivision of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Xavier ArmoiryDivision of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Caroline HigenbottamUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Nicholas CowleyWorcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK.
Rajna BasraUniversity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK.
Samuel Ian WatsonDivision of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Carolyn TarrantDepartment of Health Sciences, University of Leicester, Leicester, UK.
Amunpreet BoyalUniversity Department of Anaesthesia & Critical Care, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
Elizabeth SuttonDepartment of Health Sciences, University of Leicester, Leicester, UK.
Chia-Wei WuNational Taiwan University Hospital, Taipei, Taiwan.
Cassie P AldridgeUniversity Department of Anaesthesia & Critical Care, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
Amy GoslingUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Richard LilfordDivision of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Julian BionUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Funding

Department of Health 12/128/17
6 · The paper itself

Abstract

objectiveTo examine the magnitude of the weekend effect, defined as differences in patient outcomes between weekend and weekday hospital admissions, and factors influencing it.

designA systematic review incorporating Bayesian meta-analyses and meta-regression. DATA SOURCES: We searched seven databases including MEDLINE and EMBASE from January 2000 to April 2015, and updated the MEDLINE search up to November 2017. Eligibility criteria: primary research studies published in peer-reviewed journals of unselected admissions (not focusing on specific conditions) investigating the weekend effect on mortality, adverse events, length of hospital stay (LoS) or patient satisfaction.

resultsFor the systematic review, we included 68 studies (70 articles) covering over 640 million admissions. Of these, two-thirds were conducted in the UK (n=24) or USA (n=22). The pooled odds ratio (OR) for weekend mortality effect across admission types was 1.16 (95% credible interval 1.10 to 1.23). The weekend effect appeared greater for elective (1.70, 1.08 to 2.52) than emergency (1.11, 1.06 to 1.16) or maternity (1.06, 0.89 to 1.29) admissions. Further examination of the literature shows that these estimates are influenced by methodological, clinical and service factors: at weekends, fewer patients are admitted to hospital, those who are admitted are more severely ill and there are differences in care pathways before and after admission. Evidence regarding the weekend effect on adverse events and LoS is weak and inconsistent, and that on patient satisfaction is sparse. The overall quality of evidence for inferring weekend/weekday difference in hospital care quality from the observed weekend effect was rated as 'very low' based on the Grading of Recommendations, Assessment, Development and Evaluations framework.

conclusionsThe weekend effect is unlikely to have a single cause, or to be a reliable indicator of care quality at weekends. Further work should focus on underlying mechanisms and examine care processes in both hospital and community. PROSPERO REGISTRATION NUMBER: CRD42016036487.

Indexed as

Bayes TheoremDelivery of Health CareEmergency Service, HospitalEpidemiologic MethodsHospital MortalityHumansLength of StayMedical Staff, HospitalOutcome Assessment, Health CarePatient AdmissionPatient SafetyPatient SatisfactionTime Factorsadverse eventsBayesian meta-analysishealthcare databasesmortalitysystematic reviewweekend effect

Identifiers

PMID31164363
PMCPMC6561443

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.