The most intuitive and available explanation for the different mortality rates that have been observed recently between weekday and weekend admissions to NHS hospitals in England is certainly differences in provisions of care. whose improvement or rectification would require "Money, money, money". But I wonder if in his correctly forward-looking Data Briefing, Appleby is entirely comfortable with the way the "big data" presented in the Fremantle papers handled admissions for Day Case surgery.
I have not been able to find any specific reference to these admissions in the Fremantle papers. Nor, for that matter, any definition as to what for them constituted an admission.
A lot of care is taken in NHS hospitals to make admissions for Day Case surgery as safe and good an experience for patients as possible. It is here where Atul Gawande's famous Checklist Manifesto is most readily used to "Get Things Right". And most Day Case surgery is done on weekdays.
If the expected extremely low mortality figures for admissions for Day Case surgery were somehow to have been included with the general weekday admissions in their comparison with weekend admissions, a powerful bias in favour of the safety of weekday admissions will have been incorporated. How powerful? I've no idea; but possibly, if taken into account, enough to make the reported weekend mortality figures look significantly brilliant.
I feel I should have voiced my concerns about the possible inappropriate inclusion of admissions for Day Case surgery with other weekday admissions last September when the BMJ published the second Fremantle paper, but John Appleby is easier to read and vastly experienced with "big data" and its application to care in the NHS. Should Day Case surgery be done at the weekend to achieve daily mortality equity?
References.
Freemantle: As in Appleby paper
Atul Gawande. The Checklist Manifesto: How to Get Things Right.
Rapid Response:
Re: A 7/7 NHS: what price equity?
The most intuitive and available explanation for the different mortality rates that have been observed recently between weekday and weekend admissions to NHS hospitals in England is certainly differences in provisions of care. whose improvement or rectification would require "Money, money, money". But I wonder if in his correctly forward-looking Data Briefing, Appleby is entirely comfortable with the way the "big data" presented in the Fremantle papers handled admissions for Day Case surgery.
I have not been able to find any specific reference to these admissions in the Fremantle papers. Nor, for that matter, any definition as to what for them constituted an admission.
A lot of care is taken in NHS hospitals to make admissions for Day Case surgery as safe and good an experience for patients as possible. It is here where Atul Gawande's famous Checklist Manifesto is most readily used to "Get Things Right". And most Day Case surgery is done on weekdays.
If the expected extremely low mortality figures for admissions for Day Case surgery were somehow to have been included with the general weekday admissions in their comparison with weekend admissions, a powerful bias in favour of the safety of weekday admissions will have been incorporated. How powerful? I've no idea; but possibly, if taken into account, enough to make the reported weekend mortality figures look significantly brilliant.
I feel I should have voiced my concerns about the possible inappropriate inclusion of admissions for Day Case surgery with other weekday admissions last September when the BMJ published the second Fremantle paper, but John Appleby is easier to read and vastly experienced with "big data" and its application to care in the NHS. Should Day Case surgery be done at the weekend to achieve daily mortality equity?
References.
Freemantle: As in Appleby paper
Atul Gawande. The Checklist Manifesto: How to Get Things Right.
Competing interests: No competing interests