Hospital patients more at risk at nights and weekends, say specialists

Two intensive care specialists said a lack of consultants outside working hours meant patients were less likely to get the care they need.

People admitted to casualty with serious injuries were more likely to be assessed by a junior doctor during the night.

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They quoted a study which found that consultants were involved in 40 per cent of cases during the day, but only 12 per cent of cases during the night.

But junior doctors were far more likely to provide the wrong type of care.

Initial management of the patient was inappropriate in almost a quarter of cases when a junior doctor was in charge - compared with just 3 per cent when a consultant performed this role.

A letter by Dr Paul Frost and Dr Matt Wise, published in the British Medical Journal, quoted a recent study of the process of care for 795 badly injured patients, 493 with head injury.

It found that most turned up out of hours - after 6pm and before 8am - and therefore received sub-standard care.

The pair, from the University Hospital of Wales in Cardiff, said that as well as there not being enough consultants at night, radiology services were often unavailable and too few operating theatres were open.

"In addition to a lack of senior medical staff to coordinate management out of hours, immediate intervention for more specialised injuries was often unavailable," they said.

The researchers added that organisational deficiencies in out of hours care were not unique to the UK or to trauma care.

They said that heart attack victims were also more likely to die if they collapsed out of hours, while patients being discharged from intensive care at night and weekends are also more at risk.

Dr Frost and Dr Wise say doctors should consider the time a person was first treated in hospital before deciding how long it is likely to be before they recover.

Many hospital casualty departments are overstretched at night and weekends because GP out of hours services are poor.

In 2004, a new contract gave doctors the option of opting out of responsibility for their patients outside working hours - and more than 90 per cent did so.

Primary care trusts were supposed to find alternative provision but many failed to provide adequate cover.

It meant people were forced to call 999 or turn up at accident and emergency units for treatment.

Despite the increasing pressures on A&E, ministers' aim is to reduce the number of people going to casualty by a million a year.

They want to do this by halving the number of ambulances and replacing them with people carriers staffed by paramedics who will treat more people at home.