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The authors declare that they have no competing interest.
AB, YFC and CT drafted the initial review protocol, which was revised by all members of the writing committee. AB, CT, YFC, ES and XA independently screened the records from the initial search and developed and refined the study selection criteria and overall structure of the review. SW drafted the text related to Bayesian analysis. JB helped refine the scope and process of the review and provided senior guidance. All members of the writing committee contributed to the development of the initial logic model, provided critical input into this protocol and approved the final version for submission. YFC and CT are the guarantors of the review.
YFC is a Senior Research Fellow and experienced systematic reviewer at the Warwick Centre for Applied Health Research and Delivery, University of Warwick.
AB is a Research Fellow and registered nurse. She is an experienced qualitative researcher at the University Hospitals Birmingham NHS Foundation Trust.
ES is a Research Associate with experience in qualitative research and systematic reviews in the SAPPHIRE group, Department of Health Sciences, University of Leicester.
XA is a Senior Visiting Fellow at the University of Warwick. He is trained as hospital pharmacist and is becoming specialised in conducting systematic reviews.
SIW is a Research Fellow in Health Economics involved with statistical methods for the evaluation of service delivery interventions at the University of Warwick.
JB is a Professor of Intensive Care Medicine at the University of Birmingham and Queen Elizabeth Hospital Birmingham. He is the lead investigator for the HiSLAC project.
CT is a Senior Lecturer in the SAPPHIRE group, Department of Health Sciences, University of Leicester. She is a social scientist with expertise in qualitative research and evaluation.
Growing literature has demonstrated that patients admitted to hospital during weekends tend to have less favourable outcomes, including increased mortality, compared with similar patients admitted during weekdays. Major policy interventions such as the 7-day services programme in the UK NHS have been initiated to reduce this weekend effect, although the mechanisms behind the effect are unclear. Here, we propose a mixed methods review to systematically examine the literature surrounding the magnitude and mechanisms of the weekend effect.
MEDLINE, CINAHL, HMIC, EMBASE, EthOS, CPCI and the Cochrane Library were searched from Jan 2000 to April 2015 using terms related to ‘weekends or out-of-hours’ and ‘hospital admissions’. The 5404 retrieved records were screened by the review team, and will feed into two component reviews: a systematic review of the magnitude of the weekend effect and a framework synthesis of the mechanisms of the weekend effect. A repeat search of MEDLINE will be conducted mid-2016 to update both component reviews. The systematic review will include quantitative studies of non-specific hospital admissions. The primary outcome is the weekend effect on mortality, which will be estimated using a Bayesian random effects meta-analysis. Weekend effects on adverse events, length of hospital stay and patient experience will also be examined. The development of the framework synthesis has been informed by the initial scoping of the literature and focus group discussions. The synthesis will examine both quantitative and qualitative studies that have compared the processes and quality of care between weekends and weekdays, and explicate the underlying mechanisms of the weekend effect.
The weekend effect is a complex phenomenon that has major implications for the organisation of health services. Its magnitude and underlying mechanisms have been subject to heated debate. Published literature reviews have adopted restricted scopes or methods and mainly focused on quantitative evidence. This proposed review intends to provide a comprehensive and in-depth synthesis of diverse evidence to inform future policy and research aiming to address the weekend effect.
Systematic review registration
PROSPERO 2016: CRD42016036487