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Protocol for the health economic evaluation of increasing the weekend specialist to patient ratio in hospitals in England
  1. Samuel I Watson1,
  2. Yen-Fu Chen1,
  3. Julian F Bion2,
  4. Cassie P Aldridge2,
  5. Alan Girling3,
  6. Richard J Lilford4
  7. on behalf of the HiSLAC Collaboration
  1. 1 Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
  3. 3 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  4. 4 Division of Health and Population Sciences, Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Samuel I Watson; s.watson.1{at}


Introduction This protocol concerns the evaluation of increased specialist staffing at weekends in hospitals in England. Seven-day health services are a key policy for the UK government and other health systems trying to improve use of infrastructure and resources. A particular motivation for the 7-day policy has been the observed increase in the risk of death associated with weekend admission, which has been attributed to fewer hospital specialists being available at weekends. However, the causes of the weekend effect have not been adequately characterised; many of the excess deaths associated with the ‘weekend effect’ may not be preventable, and the presumed benefits of improved specialist cover might be offset by the cost of implementation.

Methods/design The Bayesian-founded method we propose will consist of four major steps. First, the development of a qualitative causal model. Specialist presence can affect multiple, interacting causal processes. One or more models will be developed from the results of an expert elicitation workshop and probabilities elicited for each model and relevant model parameters. Second, systematic review of the literature. The model from the first step will provide search limits for a review to identify relevant studies. Third, a statistical model for the effects of specialist presence on care quality and patient outcomes. Fourth, valuation of outcomes. The expected net benefits of different levels of specialist intensity will then be evaluated with respect to the posterior distributions of the parameters.

Ethics and dissemination The study was approved by the Review Subcommittee of the South West Wales REC on 11 November 2013. Informed consent was not required for accessing anonymised patient case records from which patient identifiers had been removed. The findings of this study will be published in peer-reviewed journals; the outputs from this research will also form part of the project report to the HS&DR Programme Board.

  • staffing
  • evidence synthesis
  • net benefits
  • health economics
  • weekend mortality
  • specialist cover

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  • Contributors SIW and RJL developed the methodology for the analysis. SIW, RJL, CPA, JFB and Y-FC discussed and refined the methods through collaborative sessions with experts. AG provided significant input to the revision of the paper and refinement of the method. SIW prepared the first draft. The final draft was approved by all authors.

  • Funding This project was funded by the National Institute for Health Research, Health Services and Delivery Research Programme (project number 12/128/17). SIW, Y-FC and RJL are part-funded/supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands.

  • Disclaimer This paper presents independent research and the views expressed are those of the author(s) and not necessarily those of the HS&DR, NHS, NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The HiSLAC study, including the case record reviews, was approved by the Review Subcommittee of the South West Wales REC on 11 November 2013.

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

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