Leeds study allays out-of-hours emergency admissions fears

Children admitted to UK intensive care units in out-of-hours emergencies are at no greater risk of dying than children arriving during normal working hours, according to new research be Leeds University boffins..

However, mortality rates are significantly higher in the winter, even after taking into account added health risks for children in the colder months.

The study, published by researchers at the University of Leeds and the University of Leicester in the Journal of Pediatrics, is the first large-scale analysis of the influence of admission times on deaths in paediatric intensive care units. It was commissioned by the Healthcare Quality Improvement Partnership and carried out by the Paediatric Intensive Care Audit Network.

Its findings are an important contribution to the debate on out-of-hours provision in the NHS, with Sir Bruce Keogh, Medical Director of NHS England, calling in February for 7-days-a-week consultant-led care.

Research in 2010 reported that patients admitted for emergency treatment at weekends were up to 10 per cent more likely to die1 and the Royal College of Pediatrics and Child Health warned in April about the large number of children admitted out of hours with serious health problems who did not see a senior paediatrician promptly2.

The new study, based on admissions to 29 paediatric intensive care units between 2006 and 2011, did not find any negative effect for either weekend or night-time emergency admissions.

The researchers did identify a near doubling of mortality risk for children admitted outside normal working hours following a planned admission. This increased risk is likely to be related to children who have undergone lengthy, complicated surgery that carries a higher risk of death.

However, the report also found a statistically significant 13 percent increase in deaths in November, December and January.

Out-of-hours admissions were defined as any admission at the weekend, night time or on a bank holiday. Weekends were defined as any time from Friday, 5 pm to 7 am on Monday morning. Night-time admissions were defined as after 8.00pm and before 8.00am.

The researchers also looked at whether the size of paediatric intensive care units had an effect on mortality rates, but found no statistically significant differences.