• Milagros Ruiz, Alex Bottle, and Paul P Aylin.
• Dr Foster Unit, PCPH Imperial College London, London, UK.
• BMJ Qual Saf. 2015 Aug 1; 24 (8): 492-504.

ObjectiveTo examine the association of mortality by day of the week for emergency and elective patients.DesignRetrospective observational study using the international dataset from the Global Comparators (GC) project consisting of hospital administrative data.Setting28 hospitals from England, Australia, USA and the Netherlands during 2009-2012.ParticipantsEmergency and surgical-elective patients.Main Outcome MeasuresIn-hospital deaths within 30 days of emergency admission or of elective surgery.ResultsWe examined 2 982 570 hospital records; adjusted odds of 30-day death were higher for weekend emergency admissions to 11 hospitals in England (OR 1.08, 95% CI 1.04 to 1.13 on Sunday), 5 hospitals in USA (OR 1.13, 95% CI 1.04 to 1.24 on Sunday) and 6 hospitals in the Netherlands (OR 1.20, 95% CI 1.09 to 1.33 on Saturday). Emergency admissions to the six Australian hospitals showed no daily variation in adjusted 30-day mortality, but showed a weekend effect at 7 days post emergency admission (OR 1.12, 95% CI 1.04 to 1.22 on Saturday). All weekend elective patients showed higher adjusted odds of 30-day postoperative death; we observed a 'Friday effect' for elective patients in the six Dutch hospitals.ConclusionsWe show that mortality outcomes for our sample vary within each country and per day of the week in agreement with previous studies of the 'weekend effect'. Due to limitations of administrative datasets, we cannot determine the reasons for these findings; however, the international nature of our database suggests that this is a systematic phenomenon affecting healthcare providers across borders. Further investigation is needed to understand the factors that give rise to the weekend effect. The participating hospitals represent varied models of service delivery, and there is a potential to learn from best practice in different healthcare systems.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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