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Research paper
Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes
  1. Melanie Turner1,
  2. Mark Barber2,
  3. Hazel Dodds3,
  4. Martin Dennis4,
  5. Peter Langhorne5,
  6. Mary-Joan Macleod1
  7. on behalf of the Scottish Stroke Care Audit
  1. 1Division of Applied Medicine, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK
  2. 2Stroke Unit, Monklands General Hospital, Airdrie, UK
  3. 3Information Services Division, NHS National Services Scotland, Edinburgh, UK
  4. 4Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
  5. 5Academic Section of Geriatric Medicine, University of Glasgow, Royal Infirmary, Glasgow, UK
  1. Correspondence to Dr Mary-Joan Macleod, Division of Applied Medicine, Department of Medicine and Therapeutics, Polwarth Building, Foresterhill, University of Aberdeen, Aberdeen AB25 2ZD, UK; m.j.macleod{at}abdn.ac.uk

Abstract

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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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