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Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays
  1. Julian Bion1,
  2. Cassie P Aldridge1,
  3. Alan Girling2,
  4. Gavin Rudge2,
  5. Chris Beet3,
  6. Tim Evans4,
  7. R Mark Temple5,
  8. Chris Roseveare6,
  9. Mike Clancy7,
  10. Amunpreet Boyal1,
  11. Carolyn Tarrant8,
  12. Elizabeth Sutton8,
  13. Jianxia Sun1,
  14. Peter Rees9,
  15. Russell Mannion10,
  16. Yen-Fu Chen11,
  17. Samuel Ian Watson11,
  18. Richard Lilford11
  19. On behalf of the HiSLAC collaboration
  1. 1 University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
  2. 2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  3. 3 Critical Care Unit, University Hospitals Birmingham NHS FT, Birmingham, UK
  4. 4 NHS Improvement, London, UK
  5. 5 Renal Unit, Heart of England NHS Foundation Trust, Birmingham, UK
  6. 6 Southern Health NHS Foundation Trust, Southampton, UK
  7. 7 University Hospital Southampton NHS Foundation Trust, Southampton, UK
  8. 8 Department of Health Sciences, University of Leicester, Leicester, UK
  9. 9 Member of the Academy of Medical Royal Colleges Patient Liaison Group, London, UK
  10. 10 Health Services Management Centre, University of Birmingham, Birmingham, UK
  11. 11 Division of Health Sciences, University of Warwick, Coventry, UK
  1. Correspondence to Professor Julian Bion; c.s.price{at}


Introduction The mortality associated with weekend admission to hospital (the ‘weekend effect’) has for many years been attributed to deficiencies in quality of hospital care, often assumed to be due to suboptimal senior medical staffing at weekends. This protocol describes a case note review to determine whether there are differences in care quality for emergency admissions (EAs) to hospital at weekends compared with weekdays, and whether the difference has reduced over time as health policies have changed to promote 7-day services.

Methods and analysis Cross-sectional two-epoch case record review of 20 acute hospital Trusts in England. Anonymised case records of 4000 EAs to hospital, 2000 at weekends and 2000 on weekdays, covering two epochs (financial years 2012–2013 and 2016–2017). Admissions will be randomly selected across the whole of each epoch from Trust electronic patient records. Following training, structured implicit case reviews will be conducted by consultants or senior registrars (senior residents) in acute medical specialities (60 case records per reviewer), and limited to the first 7 days following hospital admission. The co-primary outcomes are the weekend:weekday admission ratio of errors per case record, and a global assessment of care quality on a Likert scale. Error rates will be analysed using mixed effects logistic regression models, and care quality using ordinal regression methods. Secondary outcomes include error typology, error-related adverse events and any correlation between error rates and staffing. The data will also be used to inform a parallel health economics analysis.

Ethics and dissemination The project has received ethics approval from the South West Wales Research Ethics Committee (REC): reference 13/WA/0372. Informed consent is not required for accessing anonymised patient case records from which patient identifiers had been removed. The findings will be disseminated through peer-reviewed publications in high-quality journals and through local High-intensity Specialist-Led Acute Care (HiSLAC) leads at the 121 hospitals that make up the HiSLAC Collaborative.

  • hospital
  • weekend
  • quality
  • case record review
  • consultants

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  • Contributors JB and RL developed the initial study idea. CPA, JB and AB obtained statutory and ethics approval. JB, CPA, AG, GR, CB, TE, RMT, CR, MC, AB, CT, ES, JS, PR, RM, Y-FC, SIW and RL informed the protocol methodology. All authors contributed to writing the final report and approved the final version.

  • Funding This project was funded by the National Institute for Health Research, Health Service and Delivery Research Programme (project number 12/128/17).

  • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS and DR, NIHR, NHS or the Department of Health.

  • Competing interests JB is the Chair, NICE Acute Medical Emergencies Guideline Development Group National Clinical Guideline Centre.

  • Ethics approval The HiSLAC study, including the case record reviews, was approved by the Sub-committee of the South West Wales ResearchEthics Committee, reference13/WA/0372, on 11 November 2013.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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