The impact of consultant led weekend ward rounds in a UK district general hospital Royal Wolverhampton NHS Trust Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013 More information about this event can be found at http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx

1. The impact of consultant led weekend ward rounds in a UK District General Hospital
S Kapadia1, M Brookes1, I Ghanghro1, M Widlak1, C French2
1 The Royal Wolverhampton Hospital NHS Trust, Wolverhampton
2 University of Warwick Medical School
Year
•
•
•
2010
Results
Patients discharged
The Royal College of Physicians has emphasized the need
for two to three consultant ward rounds (WRs) per week
and recent evidence suggested that increased consultant
weekday WRs can dramatically reduce inpatient stay and
mortality rates.4
•
•
There is, however, a paucity of data to examine the
impact of consultant led WRs at weekends.
•
The contribution of weekend discharges to the overall
level of patient discharge is shown in Table 3.
To assess the impact of weekend consultant WRs on a
medical ward in a large 700 bedded District General
Hospital.
To determine whether weekend consultant WRs would
improve patient care, shorten length of stay and increase
discharge rates.
Weekday
Weekend
discharges
Discharges
Aug
65
16
Total
Sept
49
8
Oct
53
14
Data collection was restricted to 5 months before
(August - December 2010) and after (March - July 2011)
the introduction of weekend WRs.
The mean length of stay for patients discharged over a five
month period before weekend WRs commenced was
10.71 days. After changes it fell to 8.5 days (ps=ns; Table
4). This reduction was noted over weekdays as well as
weekends.
Nov
60
6
66
Dec
42
13
55
269*
57#
Year
Weekday
Weekend
Mean
discharges
discharges
LoS
LoS
LoS
2010
10.72*
10.46#
10.71■
8.81*
7.70#
8.5■
Table 4. Length (LoS) for five months before (2010) and after (2011) the introduction of weekend
ward rounds (*, #, ■ p = ns)
67
326■
Table 1. Discharges per month by weekday and weekend prior to weekend ward rounds
Weekday
Weekend
discharges
Discharges
Mar
61
20
Total
81
20
101
56
14
70
Jun
67
14
81
July
60
14
84
325*
82#
407■
Conclusions
• Consultant led weekend ward rounds have an
impact on several metrics used as a measure of
better care and value in hospitals.
81
May
Consultant led weekend WRs were introduced in
January - February 2011.
•
57
discharges
Apr
Method
Length of stay
81
2011
•
20
2011
The proportion of patients discharged at the weekend
increased from 17 to 20% (p=ns).
2010
•
80
The discharges during the week increased by 21% from
269 to 325 (p=ns).
The total numbers of patients discharged increased by
25 % after WRs commenced from a total of 326 patients
to 407 (p<0.05; Tables 1 and 2).
Objective
•
17
During the same time the number of patients discharged
at the weekend increased by 44% from 57 to 82 (p=ns).
•
Weekend %
Table 3. The percentage of patients discharged at weekends and during the week for the two study
periods
Patients with acute medical problems admitted as an
emergency, on a weekend have an increased mortality
rate compared with those admitted on weekdays 1,2,
with some estimates showing a 10% increased rate .3
•
•
83
2011
Introduction
Weekday %
discharges
• This should be evaluated further with larger
studies to determine if such changes could
have widespread benefit to the NHS.
Table 2. Discharges per month by weekday and weekend after the commencement of weekend
ward rounds (*, # p=ns, ■ p < 0.05)
References:
1. Effects of weekend admission and hospital teaching status on in-hospital mortality. Cram P et al; Am J Med. 2004 Aug 1; 117(3):151-7.
Contact: Suneil.Kapadia@ULH.nhs.uk
2. Weekend hospitalisation and additional risk of death: An analysis of inpatient data. Freemantle N et al; J R Soc Med. 2012 Feb; 105(2):74-84.
3. Weekend mortality for emergency admissions. A large, multicentre study. Aylin P et al; Qual Saf Health Care. 2010; 19:213-17.
4. An evaluation of Consultant Input into Acute Medical Admissions Management in England, Wales and Northern Ireland. Royal College of Physicians 2010.