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

Research output: Contribution to journalArticle

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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.
Original languageEnglish
Pages (from-to)138-143
Number of pages6
JournalJournal of Neurology, Neurosurgery & Psychiatry
Volume87
Issue number2
Early online date18 Aug 2015
DOIs
Publication statusPublished - 1 Feb 2016

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Stroke
Holidays
Process Assessment (Health Care)
Mortality
Deglutition
Risk Adjustment
Brain
Aspirin
Logistic Models
Outcome Assessment (Health Care)
Guidelines

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Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes. / Turner, Melanie; Barber, Mark; Dodds, Hazel; Dennis, Martin; Langhorne, Peter; MacLeod, Mary-Joan; Scottish Stroke Care Audit.

In: Journal of Neurology, Neurosurgery & Psychiatry, Vol. 87, No. 2, 01.02.2016, p. 138-143.

Research output: Contribution to journalArticle

Turner, Melanie ; Barber, Mark ; Dodds, Hazel ; Dennis, Martin ; Langhorne, Peter ; MacLeod, Mary-Joan ; Scottish Stroke Care Audit. / Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes. In: Journal of Neurology, Neurosurgery & Psychiatry. 2016 ; Vol. 87, No. 2. pp. 138-143.
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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.",
author = "Melanie Turner and Mark Barber and Hazel Dodds and Martin Dennis and Peter Langhorne and Mary-Joan MacLeod and {Scottish Stroke Care Audit}",
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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T1 - Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes

AU - Turner, Melanie

AU - Barber, Mark

AU - Dodds, Hazel

AU - Dennis, Martin

AU - Langhorne, Peter

AU - MacLeod, Mary-Joan

AU - Scottish Stroke Care Audit

N1 - 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.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - 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.

AB - 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.

U2 - 10.1136/jnnp-2015-311273

DO - 10.1136/jnnp-2015-311273

M3 - Article

VL - 87

SP - 138

EP - 143

JO - Journal of Neurology, Neurosurgery & Psychiatry

JF - Journal of Neurology, Neurosurgery & Psychiatry

SN - 0022-3050

IS - 2

ER -