Fewer people die in hospital at weekends, study finds

Meacock, R. et al. Journal of Health Services Research & Policy.Published online:  May 6 2016

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Objective: Patients admitted as emergencies to hospitals at the weekend have higher death rates than patients admitted on weekdays. This may be because the restricted service availability at weekends leads to selection of patients with greater average severity of illness. We examined volumes and rates of hospital admissions and deaths across the week for patients presenting to emergency services through two routes: (a) hospital Accident and Emergency departments, which are open throughout the week; and (b) services in the community, for which availability is more restricted at weekends.

Method: Retrospective observational study of all 140 non-specialist acute hospital Trusts in England analyzing 12,670,788 Accident and Emergency attendances and 4,656,586 emergency admissions (940,859 direct admissions from primary care and 3,715,727 admissions through Accident and Emergency) between April 2013 and February 2014.Emergency attendances and admissions to hospital and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends.

Results: Similar numbers of patients attended Accident and Emergency on weekends and weekdays. There were similar numbers of deaths amongst patients attending Accident and Emergency on weekend days compared with weekdays (378.0 vs. 388.3). Attending Accident and Emergency at the weekend was not associated with a significantly higher probability of death (risk-adjusted OR: 1.010). Proportionately fewer patients who attended Accident and Emergency at weekend were admitted to hospital (27.5% vs. 30.0%) and it is only amongst the subset of patients attending Accident and Emergency who were selected for admission to hospital that the probability of dying was significantly higher at the weekend (risk-adjusted OR: 1.054). The average volume of direct admissions from services in the community was 61% lower on weekend days compared to weekdays (1317 vs. 3404). There were fewer deaths following direct admission on weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths.

Conclusions: There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths

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Black or white coffee before anaesthesia?: A randomised crossover trial

Larsen, B. et al. European Journal of Anaesthesiology. June 2016. 33 (6). pp. 457–462

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Image source: kate mccarthy // CC BY-ND 2.0

Background: In current preoperative fasting guidelines, coffee with milk is still regarded by many as solid food. Evidence on the consequences for gastric volume of adding milk to coffee 2 h before anaesthesia is still weak.

Objectives: The aim of this study was to compare the gastric volume by MRI in healthy volunteers after drinking coffee with and without added milk.

Design: A randomised crossover trial where all participants were exposed to three coffee and milk mixtures performed as a noninferiority study with a predefined noninferiority limit of 12 ml.

Setting: Department of Day Surgery and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark. The study was conducted between August 2013 and February 2014.

Participants: Total 32 healthy volunteers, aged 18 to 71 years.

Interventions: The participants fasted for 6 h for solid food, and 2 h before the MRI examination of gastric volume, each participant ingested one of three coffee mixtures: 175 ml coffee, including either 0 or 20 or 50% full fat milk. Each participant was studied by MRI three times separated by a minimum time interval of 2 days. The order of coffee mixture ingested was determined by random allocation.

Main Outcome Measure: Gastric volume as measured by MRI.

Results: The mean gastric volume for black coffee was 27.8 ml, for coffee with 20% milk 17.9 ml and for coffee with 50% milk 20.6 ml. Compared to black coffee, the gastric volume for 20% milk was significantly decreased with a difference of −10.0 ml (95% confidence interval, −18.2, −1.8), and for 50% milk it was insignificantly decreased, −7.2 ml (95% confidence interval, −17.4, +2.9). The upper confidence interval for the difference in gastric volume between the ‘no milk added’ group and each ‘milk added’ group did not reach the noninferiority limit of 12 ml.

Conclusion: The study provides evidence that adding up to 50% full fat milk to coffee leads to no or only a minimal increase of the gastric volume 2 h later. The results support a liberalisation of policy on the addition of milk to hot drinks before planned anaesthesia.

Read the abstract here

Over 40s’ health check offers only modest health benefits, study finds

Torjesen, I.  BMJ. 2016. 353:i2504

11291-2The NHS Health Check, the risk assessment offered every five years to patients aged 40-74 in England who have no known vascular disease, provides only marginal health benefits, a study funded by the Department of Health has found.

The department commissioned researchers at Imperial College London to examine the electronic medical records of a random sample of 138 788 patients aged 40-74 registered with 462 English general practices from 2009 to 2013. Changes in outcomes of patients who attended a health check were compared with those who did not, over a median follow-up of two years.

The results, published in the Canadian Medical Association Journal, showed that just 21.4% of eligible patients attended a health check and that the 10 year risk of cardiovascular disease in those who did so was reduced by just 0.21% (95% confidence interval –0.24% to –0.19%). This is equivalent to one cardiovascular event, such as a stroke or heart attack, being avoided every year in every 4762 people.

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‘People suffer so much’ – my first work placement on a hospital ward

Johnson, S. The Guardian. Published online: 4 May 2016

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Two students reveal how they felt during their work experiences in a hospital – from first day nerves, to what it felt like to help patients

As a first-year healthcare student, there is nothing quite as exciting and nerve-wracking as your first-ever placement in a hospital. After sitting in lecture theatres and learning the theory behind diseases, medicines and more, as well as practising clinical procedures on coursemates, a stint working in a hospital will allow you to meet and treat real patients. Two students share their experiences of working in a hospital for the first time – as well as the ways in which they dealt with the highs and lows.

Read the two accounts here

Medical error—the third leading cause of death in the US

Makary, M.A. & Daniel, M. BMJ. 2016. 353:i2139

Medical error is not included on death certificates or in rankings of cause of death. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, joins us to explain why we don’t measure medical error, and why it is so important that we start.

 

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Dementia care in care homes

The Alzheimer’s Society has published Fix dementia care:  NHS and care homes.

This report marks the second phase of an Alzheimer’s Society campaign looking at the experiences of people with dementia in a range of health and care settings.  It contains the results of a survey of care home managers and the voices of people with dementia, their families and carers.  The report sets out recommendations for the government and NHS to improve the experiences of people with dementia in care homes.

Additional link: RCGP press release