• death/mortality
• emergency care systems
• emergency departments

Outcome data is often hard to find in Emergency Medicine (EM) and outcome data about the process of acute care is even rarer. As a Royal College we write clinical standards and advise on workforce strategy, but it is often hard to link those recommendations to what actually happens to patients. Han et al in a collaboration between two business schools, two biostatistics departments and a large emergency department (ED) have managed to add patient outcome data relating to ED process to the debate about what is known as the ‘weekend effect’.1 The need for such heavyweight statistical input highlights the challenge of getting a meaningful result when there so many variables in the process of care in an emergency care system.

In 2015 the then Secretary of State for Health Jeremy Hunt said in the House of Commons ‘According to an independent study conducted by the BMJ,2 there are 11 000 excess deaths because we do not staff our hospitals properly at weekends’. There was a huge row about this statement and the perception that he was implying causality but the belief in the ‘weekend effect’ led to the drive (or in many cases) the ‘foot drag’ towards 7-day services.

Anyone one who works …