Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes

Melanie Turner, Mark Barber, Hazel Dodds, Martin Dennis, Peter Langhorne, Mary-Joan MacLeod, Scottish Stroke Care Audit

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39 Citations (Scopus)
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Background The presence of a ‘weekend’ effect has been shown across a range of medical conditions, but has not been consistently observed for patients with stroke.

Aims We investigated the impact of admission time on a range of process and outcome measures after stroke.

Methods Using routine data from National Scottish data sets (2005–2013), time of admission was categorised into weekday, weeknight and weekend/public holidays. The main process measures were swallow screen on day of admission (day 0), brain scan (day 0 or 1), aspirin (day 0 or 1), admission to stroke unit (day 0 or 1), and thrombolysis administration. After case-mix adjustment, multivariable logistic regression was used to estimate the OR for mortality and discharge to home/usual place of residence.

Results There were 52 276 index stroke events. Compared to weekday, the adjusted OR (95%CI) for early stroke unit admission was 0.81 (0.77 to 0.85) for weeknight admissions and 0.64 (0.61 to 0.67) for weekend/holiday admissions; early brain scan 1.30 (0.87 to 1.94) and 1.43 (0.95 to 2.18); same day swallow screen 0.86 (0.81 to 0.91) and 0.85 (0.81 to 0.90); thrombolysis 0.85 (0.75 to 0.97) and 0.85 (0.75 to 0.97), respectively. Seven-day mortality, 30-day mortality and 30-day discharge for weekend admission compared to weekday was 1.17 (1.05 to 1.30); 1.08 (1.00 to 1.17); and 0.90 (0.85 to 0.95), respectively.

Conclusions Patients with stroke admitted out of hours and at weekends or public holidays are less likely to be managed according to current guidelines. They experience poorer short-term outcomes than those admitted during normal working hours, after correcting for known independent predictors of outcome and early mortality.
Original languageEnglish
Pages (from-to)138-143
Number of pages6
JournalJournal of Neurology, Neurosurgery & Psychiatry
Issue number2
Early online date18 Aug 2015
Publication statusPublished - 1 Feb 2016

Bibliographical note

Acknowledgements The authors are grateful to David Murphy of the SSCA for
providing data and to Lynsey Waugh of ISD Scotland for linking the SSCA data with
General Register Office data. The authors also acknowledge the help of all who
enter data into SSCA.

Funding This study was funded by Chest, Heart and Stroke Scotland (Grant no
R14/A156). The SSCA is funded by NHS Scotland via ISD.


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