Skip to main content Accessibility help

Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

  • Rashmi Patel (a1), Edward Chesney (a1), Alexis E. Cullen (a2), Alex D. Tulloch (a3), Matthew Broadbent (a4), Robert Stewart (a5) and Philip McGuire (a6)...



Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals.


To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes.


Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week.


There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient –21.1 days, 95% CI –24.6 to –17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week.


Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.


Corresponding author

Rashmi Patel, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. Email:


Hide All

These authors contributed equally to the work.

Declaration of interest

The CRIS team members M.B. and R.S. have received research funding from Roche, Pfizer, Johnson & Johnson and Lundbeck. P.M. has received research funding from Janssen, Sunovion, GW and Roche.



Hide All
1 Ruiz, M, Bottle, A, Aylin, PP. The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week. BMJ Qual Saf 2015; 24: 492504.
2 Attenello, FJ, Wen, T, Cen, SY, Ng, A, Kim-Tenser, M, Sanossian, N, et al. Incidence of ‘never events’ among weekend admissions versus weekday admissions to US hospitals: national analysis. BMJ 2015; 350: h460.
3 Aylin, P, Yunus, A, Bottle, A, Majeed, A, Bell, D. Weekend mortality for emergency admissions. A large, multicentre study. Qual Saf Heal Care 2010; 19: 213–7.
4 Freemantle, N, Richardson, M, Wood, J, Ray, D, Khosla, S, Shahian, D, et al. Weekend hospitalization and additional risk of death: an analysis of inpatient data. J R Soc Med 2012; 105: 7484.
5 Freemantle, N, Ray, D, McNulty, D, Rosser, D, Bennett, S, Keogh, BE, et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ 2015; 351: h4596.
6 Handel, AE, Patel, SV, Skingsley, A, Bramley, K, Sobieski, R, Ramagopalan, SV. Weekend admissions as an independent predictor of mortality: an analysis of Scottish hospital admissions. BMJ Open 2012; 2: e001789.
7 Voltz, R, Kamps, R, Greinwald, R, Hellmich, M, Hamacher, S, Becker, G, et al. Silent night: retrospective database study assessing possibility of ‘weekend effect’ in palliative care. BMJ 2014; 349: g7370.
8 Palmer, WL, Bottle, A, Aylin, P. Association between day of delivery and obstetric outcomes: observational study. BMJ 2015; 351: h5774.
9 Concha, OP, Gallego, B, Hillman, K, Delaney, GP, Coiera, E. Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study. BMJ Qual Saf 2014; 23: 215–22.
10 McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S. Paying the Price: The Cost of Mental Health Care in England to 2026. The King's Fund, 2008.
11 Jacobs, R, Barrenho, E. Impact of crisis resolution and home treatment teams on psychiatric admissions in England. Br J Psychiatry 2011; 199: 71–6.
12 Stewart, R, Soremekun, M, Perera, G, Broadbent, M, Callard, F, Denis, M, et al. The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry 2009; 9: 51.
13 Fernandes, AC, Cloete, D, Broadbent, MTM, Hayes, RD, Chang, C-K, Jackson, RG, et al. Development and evaluation of a de-identification procedure for a case register sourced from mental health electronic records. BMC Med Inform Decis Mak 2013; 13: 71.
14 Patel, R, Shetty, H, Jackson, R, Broadbent, M, Stewart, R, Boydell, J, et al. Delays before diagnosis and initiation of treatment in patients presenting to mental health services with bipolar disorder. PLoS One 2015; 10: e0126530.
15 Patel, R, Lloyd, T, Jackson, R, Ball, M, Shetty, H, Broadbent, M, et al. Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ Open 2015; 5: e007504.
16 Patel, R, Jayatilleke, N, Broadbent, M, Chang, C-K, Foskett, N, Gorrell, G, et al. Negative symptoms in schizophrenia: a study in a large clinical sample of patients using a novel automated method. BMJ Open 2015; 5: e007619.
17 Fusar-Poli, P, Díaz-Caneja, CM, Patel, R, Valmaggia, L, Byrne, M, Garety, P, et al. Services for people at high risk improve outcomes in patients with first episode psychosis. Acta Psychiatr Scand 2016; 133: 7685.
18 UK Government Digital Service. UK Bank Holidays. GOV.UK (
19 Beer, MD, Pereira, SM, Paton, C. Psychiatric Intensive Care. Cambridge University Press, 2008.
20 Department of Health. Code of Practice: Mental Health Act 1983. Department of Health, 2015 (
21 Bowers, L, Cullen, A, Pettit, S, Achilla, E, Moylan, L, Sethi, F, et al. Seclusion and psychiatric intensive care evaluation study. Unpublished; project portfolio available at
22 Office for National Statistics. Ethnic Group. Office for National Statistics, no date (
23 Cohen, J. Statistical Power Analysis for the Behavioral Sciences (2nd edn). Routledge, 1988.
24 Barcham, C. The Pocketbook Guide To Mental Health Act Assessments. McGraw-Hill Education, 2012.
25 Ahmed, AG, Lepnurm, M. Seclusion practice in a Canadian forensic psychiatric hospital. J Am Acad Psychiatry Law Online 2001; 29: 303–9.
26 Soloff, PH, Turner, SM. Patterns of seclusion: a prospective study. J Nerv Ment Dis 1981; 169: 3744.
27 Tunde-Ayinmode, M, Little, J. Use of seclusion in a psychiatric acute inpatient unit. Australas Psychiatry 2004; 12: 347–51.
28 Barlow, K, Grenyer, B, Ilkiw-Lavalle, O. Prevalence and precipitants of aggression in psychiatric inpatient units. Aust NZ J Psychiatry 2000; 34: 967–74.
29 George, L, Durbin, J, Sheldon, T, Goering, P. Patient and contextual factors related to the decision to hospitalize patients from emergency psychiatric services. Psychiatr Serv 2002; 53: 1586–91.
30 Unick, GJ, Kessell, E, Woodard, EK, Leary, M, Dilley, JW, Shumway, M. Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service. Gen Hosp Psychiatry 2011; 33: 618–25.
31 McGarvey, EL, Leon-Verdin, M, Wanchek, TN, Bonnie, RJ. Decisions to initiate involuntary commitment: the role of intensive community services and other factors. Psychiatr Serv 2013; 64: 120–6.
32 Green, BH, Griffiths, EC. Hospital admission and community treatment of mental disorders in England from 1998 to 2012. Gen Hosp Psychiatry 2014; 36: 442–8.
33 Shepherd, G, Beadsmoore, A, Moore, C, Hardy, P, Muijen, M. Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross sectional survey, one day census data, and staff interviews. BMJ 1997; 314: 262.
34 Mental Health Taskforce. The Five Year Forward View for Mental Health for the NHS in England. Mental Health Taskforce, 2016 (
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

  • Rashmi Patel (a1), Edward Chesney (a1), Alexis E. Cullen (a2), Alex D. Tulloch (a3), Matthew Broadbent (a4), Robert Stewart (a5) and Philip McGuire (a6)...
Submit a response


Improving weekend community services could potentially help avoid unnecessary hospital admissions

Feras A Mustafa, Psychiatrist, Northamptonshire Healthcare NHS Foundation Trust
02 May 2016

Weekend psychiatric admissions have been shown to be associated with shorter duration, less compulsion, fewer seclusions and reduced mortality (1). These more favourable outcomes suggest that less unwell patients are being admitted to hospital at weekends compared with weekdays, probably due to reduced community services. The study by Patel et al has further revealed that patients with certain characteristics such as female gender, ethnic minority and those admitted from sources other than home, are more likely to be admitted at weekends (1). Thus, one could speculate that mental health professionals, operating with limited resources at weekends, have a lower threshold for admitting patients whom they perceive as vulnerable. Hence, investing in improved weekend community services could potentially help avoid unnecessary hospital admissions.

Nonetheless, there is a couple of methodological issues that require consideration. First, weekends effectively start on Friday afternoon with reduced, or on-call, arrangements replacing regular services till Monday morning. Therefore, admissions that took place between Friday afternoon and Saturday morning during the nine-year study period were in reality exposed to the weekend effect, yet they were treated as weekday admissions which may have potentially attenuated the differences between the two admission categories.

Second, the study examined hospital admissions between 2006 and 2015, a period which coincided with significant reforms to mental health and social services as well as the introduction of the new mental health act. It therefore would have been informative to show differences between weekend and weekday admissions over individual years and whether there have been any trends over time.


1Patel R, Chesney E, Cullen AE, Tulloch AD, Broadbent M, Stewart R, et al. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital. Br J Psychiatry April 2016, DOI: 10. 1192/bjp.bp.115. 180307

... More

Conflict of interest: None Declared

Write a reply


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *