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Seven Day NHS: improving outcomes for patients admitted at weekends?

Whether or not you were happy with the election result on May 8th 2015, I like to hope that very few people will complain about the conservative pledge to making sure emergency departments and GP surgeries are manned around the clock – a ‘seven day’ NHS.

Weekend care

It is a shocking statistic that research published by the Royal Society of Medicine in 2012 revealed that death rates for patients admitted to hospital in the UK on a Sunday are up to 16 per cent higher than on a Wednesday. There is also evidence to suggest that mortality rates are higher over the Christmas period, when staff levels are reduced.

NHS England has acknowledged that hospital care suffers at the weekends, and plans are in place to ensure more senior doctors are available to prevent problems and complications escalating into life-threatening situations.

JLH v County Durham & Darlington NHS Foundation Trust

The clinical negligence case of JLH v County Durham & Darlington NHS Foundation Trust concerns the tragic death of a young mother as a result of failings in her medical care around the new year period.  The patient was admitted to hospital on 30th December for an elective caesarean section delivery of her twin babies.  The patient lost a moderate amount of blood during the procedure.

Following the surgery her condition deteriorated and she continued to lose blood. At 21.55 that evening the Doctor decided not to start a blood transfusion.

On 31st December it was noted that the patient had a poor urine output and she was diagnosed to be suffering from acute renal failure and was eventually transferred to a high dependency unit. By January 3rd a diagnosis of possible pre-eclampsia or HELLP (involving haemolysis, elevated liver enzymes and low platelet count) syndrome was given, however her condition continued to deteriorate and she started to show signs of cerebral irritation. The following day she underwent neurosurgery for a cranial bleed, the bleeding continued and on January 20th she had a brain stem death. Treatment was withdrawn and she sadly died.

The allegations included:

• The failure to administer a Syntocinon infusion following delivery on 30th December;

• Failing to follow the hospital’s postpartum haemorrhage protocol by not carrying out clotting studies and group and cross matches;

• Failing to observe or monitor urine output;

• Failing to provide a blood transfusion on December 30;

Liability for the patient’s death was admitted by the Trust.

Other issues noted in the case included delays in seeking reviews by more senior doctors and, following this case, the hospital advised that changes had been implemented, including that they had increased the number of Consultant hours available in the maternity unit.

What we hope for:

My experience in acting for patients pursuing clinical negligence claims is that there does appear to be a discrepancy in relation to the care provided at different times of the week and year, with ‘out of hours’ patients having to wait longer, particularly if they require care from more senior medical staff.  These delays frequently mean that the seriousness of a condition can go undiagnosed leading to the patient deteriorating and in the worst cases causing the death of the patient.

I hope that increased staff levels, particularly at weekends, will reduce the number of avoidable patient deaths at these times and ensure that care given to patients at any time during the week or year is consistent. This is vital as patients cannot choose when they may need emergency life-saving care.

An important finding from a care report by the Medical Royal Colleges suggests that increased consultant presence at weekends will also enhance the learning opportunities for junior staff which will hopefully also in turn then improve the care patients receive from those junior doctors.

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