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

Turner, M., Barber, M., Dodds, H., Dennis, M., Langhorne, P. and Macleod, M.-J. (2016) Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes. Journal of Neurology, Neurosurgery and Psychiatry, 87, pp. 138-143. (doi:10.1136/jnnp-2015-311273) (PMID:26285585) (PMCID:PMC4752676)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Langhorne, Professor Peter
Authors: Turner, M., Barber, M., Dodds, H., Dennis, M., Langhorne, P., and Macleod, M.-J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of Neurology, Neurosurgery and Psychiatry
Publisher:BMJ Publishing Group
ISSN:0022-3050
ISSN (Online):1468-330X
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Journal of Neurology, Neurosurgery and Psychiatry 87:138-143
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
653981Setting Scottish Stroke Services in an International ContextPeter LanghorneChest, Heart & Stroke, Scotland (CHSS)R14/A156RI CARDIOVASCULAR & MEDICAL SCIENCES