An operating theatre in a hospital

Key impact:

  • Mortality alerts to the Care Quality Commission led to investigation into Mid Staffordshire Trust
  • Highlighted a rise in in-hospital mortality following the junior doctor changeover in August, which was followed by improvements in induction for new hospital doctors
  • Demonstrated poorer outcomes for patients in hospital during the weekend compared with during the week, leading to calls for 24/7 working
  • Showed the value of administrative healthcare data in the measurement and monitoring of hospital quality in the UK and internationally.

More deaths from surgery closer to the weekend

Patients undergoing planned surgery appear more likely to die if they have their operation at the end of the week, a study published by Paul Aylin and

From the outset, research by the Dr Foster Unit has made a considerable impact on national policy and the research agenda. In short, we have shown the value of hospital administrative data for measuring and monitoring the quality and safety of healthcare here in the UK and abroad.


The value of our methodological contribution to the public inquiries into children’s heart surgery at the Bristol Royal Infirmary and into the crimes of GP Harold Shipman was recognised by the inquiries’ chairmen:

“[Their work] is innovative and, as I had hoped, it has made a real contribution to the debate about the feasibility and the value of setting up a system for the routine monitoring of mortality rates among the patients of GPs” (Dame Janet Smith in her final report for the Shipman Inquiry).

“The Hospital Episode Statistics database should be supported as a major national resource which can be used reliably, with care, to undertake the monitoring of a range of healthcare outcomes” (Ian Kennedy in her final report for the Bristol Royal Infirmary Inquiry).

After we had shown in these two inquiries and related work [ref the inquiries and our BMJ casemix paper] the potential for statistical monitoring of hospital outcomes using routine data, we developed a system to do this using England’s national database, HES. This system is used by managers and clinicians in over two-thirds of NHS hospital trusts to monitor quality of care and was pivotal in alerting the then Healthcare Commission (HCC) to problems at the Mid Staffordshire NHS Foundation Trust. This led to Department of Health reviews of mortality data and monitoring. The national regulator also still uses HES data in its work.

Our research has increased the use of administrative data in the management and monitoring of healthcare in the UK and internationally [link to international page]. We continue to develop and assess the value of new measures of quality and safety such as unplanned reoperations and patient safety incidents.


Our analyses of mortality rates by day of the week admissions and around the junior doctor changeover have led to real policy changes. Our work on both emergency and elective patients in hospital during the weekend [refs] has stimulated recent NHS moves to provide 24/7 high quality care in the NHS. Our findings of an increase in hospital death rates during the junior doctor changeover have resulted in recommendations put forward by the Academy of Medical Royal Colleges for improved consultant cover7 and for a program of shadowing for F1 doctors before they commence work.8

One of our most cited papers, “Mortality associated with delay in operation after hip fracture”, underpins the NICE Clinical Guideline on hip fracture which recommends that hospitals “Perform surgery on the day of, or the day after, admission”.

Media coverage


Weekend mortality
Published researchMedia coverage
Aylin P; Yunus A; Bottle A; Majeed A; Bell D. (28 Jan 2010). Weekend mortality for emergency admissions. A large, multicentre study. Qual Saf Health Care Publisher's link.

Weekend emergency patients 'have higher death rate' - The Guardian (11 June 2010)

Emergency admissions at weekend 'more likely to die' - Reuters (11 June 2010)

Paul Aylin interview with Ritula Shah - BBC Radio 4 (12 June 2010)

Summary of the table's contents
Junior doctors
Published researchMedia coverage
Min Hua Jen M, Bottle A, Majeed A, Bell D, Aylin P. Early In-Hospital Mortality following Trainee Doctors' First Day at Work. PLoS ONE 2009 Publisher's link.

Deadliest month: As new doctors start in August, mortality rate in A&E departments rises by 6 per cent - Daily Mail (23 September 2009)

'Deaths rise' with junior doctors - BBC News (22 September 2009)

NHS hospital deaths rise on day junior doctors join wards, study finds - The Guardian (23 September 2009)

Study proves 'killing season' occurs as new doctors start work - The Herald (23 September 2009)

Can new doctors be harmful to your health? - TIME (25 September 2009)

Hospital deaths linked to junior doctor intake - Belfast Telegraph (23 September 2009)

A bad time to get sick? - Nursing Times (24 September 2009)

Summary of the table's contents
Hospital admissions among children
Published researchMedia coverage
Saxena S; Bottle A; Gilbert R; Sharland M. (2009). Increasing short-stay unplanned hospital admissions among children in England; time trends analysis '97-'06. PLoS One. 4:e7484-e7484. Publisher's link Children needlessly admitted to hospital 'because of removal of GP out of hours cover' - The Telegraph (15 October 2009)
Summary of the table's contents
Monitoring performance
Published researchMedia coverage
Bottle A, Aylin P. Intelligent Information: a national system for monitoring clinical performance. Health Services Research Feb 2008 Publisher's link

Can we trust the data on hospitals? - BBC News (27 November 2009)

Hospital death data 'misleading' - BBC News (18 March 2009)

Summary of the table's contents