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Bion J, Aldridge C, Beet C, et al. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. Southampton (UK): NIHR Journals Library; 2021 Jul. (Health Services and Delivery Research, No. 9.13.)

Cover of Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study

Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study.

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Appendix 3Characteristics of studies included in the quantitative systematic review reported

Study [rating of statistical adjustment]aCountry [number of hospitals]Study periodSample size (admissions, unless otherwise stated)Type of admission (emergency, elective)Type of procedure (medical, surgical, maternity)PopulationMortality outcomesOther outcomes: adverse events, length of stay, patient satisfaction
All admissions (including both medical and surgical, emergency and elective admissions)
Attenello 201553 [3]USA (nationwide) [NR]2002–10351,170,803Emergency and electiveMedical and surgicalAll patientsIn hospitalHospital-acquired conditions
Auger 201586 [4]USA (Michigan) [1]2006–1255,383Emergency and electiveMedical and surgicalChildren only–Unplanned re-admission
Coiera 2014182 [3]Australia (New South Wales) [501]2000–711,732,260Emergency and electiveMedical, surgical and maternityAll patientsIn/out of hospital up to 7 days post dischargeb–
Cram 200480 [2b or 3]cUSA (California) [NR]19981,100,984Emergency and electiveMedical and surgicalAdults onlyIn hospital–
Earnest 2006183 [4]Singapore [1]2003–445,395Emergency and electiveMedical and surgicalAdults only–Length of stay
Freemantle 201269 [2b]UK (England) [NR] and USA (United Health Care System) [254]2009–1014,217,640Emergency and electiveMedical, surgical and maternityAll patientsIn/out of hospital (30 days); also in hospital (30 days) and 3 days–
Freemantle 201520 [2b]UK (England) [NR]2013–1414,818,374Emergency and electiveMedical, surgical and maternityAll patientsIn/out of hospital (30-day)Length of stay
Graham 201899 [4]UK (England) (NR)201459,083Emergency and electiveMedical and surgicalAdults only–Patient satisfaction
Lee 201264 [4]Malaysia (Perak) [1]2008–10126,627Emergency and electiveMedical and surgicalAll patientsIn hospital–
Mohammed 201275 [3]UK (England) [NR]2008–94,640,516Emergency and electiveMedical and surgicalAdults onlyIn hospital (at discharge)
Ruiz 201559 [3]International: UK (England) [11], Australia [6], the Netherlands [6], USA [5]2009–122,982,570Emergency (all) and elective (surgical only)Medical and surgicalAll patientsIn hospital (30 days)–
Medical admissions
Madsen 201462 [4]Denmark (nationwide) [72]1995–20122,651,021Emergency and electiveMedicalAdults onlyIn hospital and 30 daysb–
Surgical admissions
Bendavid 200787 [3]USA (New York, Massachusetts, North Carolina) [NR]1999–20014,967,114Emergency and electiveSurgical and obstetricAll patients–AHRQ Patient Safety Indicator (surgical and birth complications)
Gordon 200582 [4]USA (VA hospital) [44]1991–378,546Emergency and electiveSurgical (non-cardiac)AdultsIn hospital (30 days)–
Ozrazgat-Baslanti 201688 [3]USA (Florida) [1]2000–1050,314Emergency and electiveSurgicalAdults only–Post-operative complications
Emergency admissions: medical and surgical
Aldridge 201635 [3]UK (England) [141]2013–144,422,387EmergencyMedical and surgicalAdults onlyIn hospital–
An 201785 [3]USA (nationwide) [NR]2003–1351,762,178Non-electiveMedical, surgical and maternityAdults onlyIn hospitalLength of stay
Anselmi 2017142 [2b]UK (England) [140]2013–143,027,946EmergencyMedical and surgicalNot statedIn hospital (30 days)–
Aylin 201068 [3]UK (England) [163]2005–64,317,866EmergencyMedical and surgicalAdults and childrenIn hospital–
Barba 200666 [3]Spain (Madrid) [1]1999–200335,993EmergencyMedical and surgicalAdults onlyIn hospital (2 days and any)–
Bell 200124 [4]dCanada (Ontario) [NR]1988–973,789,917EmergencyMedical and surgicalAdults and childrenIn hospitalb–
De Giorgi 201563 [4]Italy (Ferrara) [1]2000–13411,588EmergencyMedical and surgicalAll patientsIn hospital (30 days)–
Han 201871 [2b]UK (Salford) [1]2004–14246,350EmergencyMedical and surgicalAdults onlyIn hospital, 7 days and 30 days–
Handel 201272 [4]UK (Scotland) [NR]1999–20095,271,327EmergencyMedical and surgicalAll patientsIn hospital–
Lee 200667 [3]Taiwan (province of China) (nationwide) [NR]2000–2712,787eEmergencyMedical and surgicalAdults and childrenIn/out of hospital (24 hours, 48 hours, 30 days)–
Meacock 201529 [4]UK (England) [NR]2010–115,212,973EmergencyMedical and surgicalNot statedIn/out of hospital (30 days)b–
Meacock 2017106 [2b]UK (England) [140]2013–144,656,586EmergencyMedical and surgicalAll patientsIn hospital (30 days)–
Meacock 2018154 [3]UK (England) [123]2013–16Not statedEmergency (also included supplementary data on all admissions)Medical and surgicalNot statedIn/out of hospital (30 days)–
Perez Concha 201458 [3]Australia (New South Wales) [501]2000–73,381,962EmergencyMedical and surgicalAll patientsIn/out of hospital (7 days); also reported in hospital and post discharge separately–
Ricciardi 2011184 [3]USA (nationwide) [1000]2003–729,991,621EmergencyMedical and surgicalAll patientsIn hospital (vital status at discharge)–
Ricciardi 2014185 [3]USA (nationwide) [1000]2003–826,051,775EmergencyMedical and surgicalAll patientsIn hospital (vital status at discharge)b–
Ricciardi 201689 [4]USA (nationwide) [1000]2003–828,236,749EmergencyMedical and surgicalAll patientsIn hospital (vital status at discharge)Patient safety indicators
Roberts 201578 [4]UK (England and Wales) [NR]2004–1232,628,333EmergencyMedical and surgicalNot stated30 days (location not specified)–
Sharp 2013186 [4]USA (nationwide) [NR]20084,225,973EmergencyMedical and surgicalAdults onlyMortality (not specified)–
Shiue 2017187 [4]UK (Newcastle Upon Tyne) [1]2010–15148,996EmergencyMedical and surgicalNot statedIn/out of hospital (30 days)–
Sullivan 2016188 [4]Australia (Queensland) [1]2011 and 201334,184EmergencyMedical and surgicalAll patientsIn hospital (timing not specified)–
Walker 201754 [1]UK (Oxford) [4]2006–14503,938EmergencyMedical and surgicalAll patientsIn/out of hospital (30 days)Admission to ICU
Emergency medical admissions
Conway 2016,55 2017,189 2017190 [2a or 4]fIreland (Dublin) [1]2002–1482,368EmergencyMedicalAll patientsIn hospital (30 days)–
Khanna 201152 [2b]USA (Chicago) [1]2008824EmergencyMedicalAll patients–Need for ICU, 30-day ED revisit, 30-day re-admission, poor outcomes in the first 24 hours
Maggs 201073 [4]UK (Bath) [1]2007–815,594EmergencyMedicalAdults onlyIn hospital and ‘late’ mortality (in-hospital death beyond the first 7 days)–
Mikulich 201126 [2a]Ireland (Dublin) [1]2002–925,833EmergencyMedicalAdults onlyIn hospital (30 days)Length of stay
Mohammed 201756 [2a]UK (Yorkshire and Humberside) [4]201447,117EmergencyMedicalAdults onlyIn hospital (vital status at discharge)Length of stay
Vest-Hansen 2015191 [4]Denmark (nationwide) [NR]2010174,192EmergencyMedicalAdults onlyIn/out of hospital (30 days)Length of stay
Emergency surgical admissions
Beecher 2015192 [4]Ireland (Galway) [1]2012-137041EmergencySurgicalNot stated–Length of stay
Gillies 201770 [3]UK (Scotland) [NR]2005–750,844EmergencySurgicalAdults onlyIn hospital or within 30 days; overall survival (4 years)–
Goldstein 201481 [2b]USA (nationwide) [NR]1988–2010439,457EmergencySurgicalChildren onlyIn hospitalVarious surgical complications; length of stay
McCallum 201674 [2b]UK (Northern England) [NR]2000–14370,671EmergencySurgicalAdults onlyIn hospital (30 days)Length of stay
Ozdemir 2016193 [3]UK (England) [156]2005–10294,602EmergencyGeneral surgicalAll patientsIn/out of hospital (30 days and 90 days)–
Zapf 201584 [3]USA (Florida) [NR]2007–1080,861EmergencySurgicalAll patientsIn hospital (timing not specified)Post-operative complications, length of stay
Elective surgical admissions
Aylin 2013194 [2b]UK (England) [163]2008–114,133,346ElectiveSurgicalAdults and childrenIn/out hospital, (30 days and 2 days)–
Dubois 201790 [2b]Canada (Ontario) [NR]2002–12402,899ElectiveSurgical (day of surgery)Adults onlyIn/out of hospital (30 days), also 2 days and 90 days and in hospitalAdmission to ICU; re-admission (30 days); reoperation (30 days); length of stay
McIsaac 201461 [2b]Canada (Ontario) [NR]2002–12333,344ElectiveSurgical (non-cardiac)Adults only (aged ≥ 40 years)In/out of hospital (30 days and 2 days)–
Ruiz 201679 [2b]UK (England) [163]2008–113,922,091ElectiveSurgicalAdults and childrenIn/out of hospital (30 days)–
Zare 200791 [2b]USA (VA hospitals) [124]2000–4188,212ElectiveSurgicalAdults only30 days (location not specified)Post-operative morbidity (complications)
Maternity admissions
de Graaf 201092 [2b]The Netherlands (nationwide) [99]2000–6764,406Spontaneous and electiveMedical and surgicalMaternityIntrapartum and early neonatal (within 7 days of birth)5-minute Apgar score of < 7; transfer to neonatal ICU
Frank-Wolf 201793 [4]Israel [1]2005–1456,428Spontaneous and electiveMedical and surgicalMaternity–Cord blood pH of < 7; 5-minute Apgar score of < 7
Gijsen 201265 [2b]The Netherlands (nationwide) [NR]2003–7449,714SpontaneousMedical and surgicalMaternityIntrapartum and early neonatal (within 7 days of birth)5-minute Apgar score of < 7; a composite measure of adverse outcomes
Gould 200383 [3]USA (California) [NR]1995–71,615,041Spontaneous and electiveMedical and surgicalMaternityNeonatal mortality (within 28 days of birth)–
Hamilton 2006195 [4]USA (Texas) [NR]1999–2001923,905Not statedNot statedMaternityNeonatal mortality (within 27 days of birth)b–
Luo 200460 [4]Canada (nationwide, excluding Ontario) [NR]1985–983,239,972Spontaneous and electiveMedical and surgicalMaternityNeonatal mortality (within 6 days of birth)–
Lyndon 201594 [4]USA (California) [NR]2005–71,475,593Spontaneous and electiveMedical and surgicalMaternity–Pelvic morbidity, severe maternal morbidity
Palmer 201576 [2b]UK (England) [NR]2010–121,332,835 maternity admissions and 1,349,599 birthsSpontaneous and electiveMedical and surgicalMaternity and neonatesIn-hospital perinatal mortalityMaternal and neonatal infections, emergency re-admissions and injuries
Pasupathy 201077 [3]UK (Scotland) [NR]1985–20041,039,560Spontaneous and electiveMedical and surgicalMaternity and neonatesNeonatal mortality (within first week of birth)–
Salihu 2012196 [4]USA (Missouri)1989–97Not statedSpontaneous and electiveMedical and surgicalMaternity and neonatesNeonatal, post-neonatal and infant death–g
Snowden 2013197 [4]USA (California) [257]2006462,322Spontaneous and electiveMedical and surgicalMaternity–Birth asphyxia
Snowden 201795 [4]USA (California) [214]2009–10724,967Spontaneous and electiveMedical and surgicalMaternityNeonatal death (timing not specified)Adverse maternal and neonatal outcomes (including prolonged length of stay)
Wu 201196 [4]USA (California) [NR]1999–20021,864,766Spontaneous and electiveMedical and surgicalMaternity–Neonatal encephalopathy
Other
Buckley 201297 [4]Australia (New South Wales) [63]2006–104370 clinical management incidentsUnclearUnclearUnclear–Adverse events

AHRQ, Agency for Healthcare Research and Quality; NR, not reported; VA, Veterans Affairs.

a

[1] Comprehensive adjustment; [2a] adequate adjustment – acute physiology; [2b] adequate adjustment – contextual factors; [3] partial adjustment; and [4] inadequate adjustment. See Appendix 1 for further details.

b

Not included in meta-analyses owing to a lack of required data (e.g. variance/standard errors of the estimates and sample size).

c

Rated 2b for stratified analyses that were restricted to admissions through the ED, as the contextual factor (route of admission) was accounted for in this analysis.

d

Only crude (unadjusted) data were reported for overall weekend effect; adjusted analyses were reported only for specific conditions that were not included in meta-analyses of this review.

e

For each patient, only the last EA during the study period was included.

f

Statistical adjustment was poorly reported in one of the articles.49

g

Reported ‘labour complications’ (e.g. placental abruption and placenta praevia), but these were adverse maternal outcomes associated with maternal conditions and are not considered adverse events as defined in this review.

Copyright © Queen’s Printer and Controller of HMSO 2021. This work was produced by Bion et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Bookshelf ID: NBK571890
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