Hospital 7 days working. Recommendations and feasibility Introduction: There is increasing evidence that mortality rates for patients admitted to hospitals are higher at weekends. Furthermore, there is evidence that five-day working costs lives. Increased mortality rates over weekends equate to an increased risk of dying of 11% for a patient presenting on a Saturday and a similar rise of 16% for a Sunday when compared to patients presenting Monday to Friday. One reason suggested for this increased mortality rate is the lack of senior doctor cover and the decreased availability of services over the weekend. During the weekend, on average, only 10-15% of consultants are present in the hospital, even though the weekend comprises 30% of the week. There is also data that shows that the risk of death from an elective procedure is 1.4 times higher if the operation is done on a Friday and 1.8 times higher for a Saturday. We review Sir Bruce Keoh's report -NHS medical Director of the UK by focusing on the feasibility and the impact on health services by putting patient in the centre of care. Methods: The Keoh report was published in November 2013 after concerns have been raised about the discrepancy in mortality and morbidity between weekday and weekends. Levels of service has been categorised into 4 levels as shown in the table 1 Most Hospitals currently are at the level 2-3. Results: In order to implement this change into the health care, 10 standards have been recommended (table 2). The local and national incentives are estimated to be over a 3 year period as follows: Year 1 - local contracts will include an Action Plan to deliver the clinical standards within the Service Year 2 - Clinical standards with the greatest impact will be incorporated into the NHS Standard Contract. Year 3 - all clinical standards will be incorporated nationally into the NHS Standard Contract with sanctions in place for non-compliance. Conclusion: With the implementation of this 7 days working model, morbidity and mortality for the weekends is estimated to decrease to the weekday level, resulting in an overall reduction in total mortality and morbidity rates over the whole week. Furthermore, the inappropriate admissions caused by the decreased availability of weekend senior decision making will diminish, in turn, reducing the costs incurred by unnecessary and protracted hospital stays and additional use of health services. Nevertheless one should consider the constrains of such services (table 3) These recommendations are set for the National Health services of the UK and perhaps could be adjusted as per country, locality and patient needs.


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