title: Off-hour effects on stroke care and outcome in stroke centres.
abstract: OBJECTIVE
  Poorer stroke care processes and outcomes have been reported for acute stroke patients arriving at centres during off hours and weekends.
  
  
  OBJECTIVE
  To compare each step of the continuous specialized care that Stroke Centres (SC) provide according to time of admission and final outcome.
  
  
  METHODS
  Observational study of consecutive stroke patients admitted to SC during 2008 and 2009. Patients were classified into two groups according to their arrival time: Work Hours (WH) and Off Hour (OH) (weekends and any time other than 8:00 am to 3:00 pm on weekdays). Differences in time to diagnostic procedures, tPA administration, stroke outcome [modified Rankin Scale, (mRS)] and in-hospital fatality rates were analysed.
  
  
  RESULTS
  A total of 912 patients were admitted. Data from 674 patients fulfilling study criteria were analysed. A total of 434 (64.4%) patients arrived during OH. No differences in stroke severity were found when comparing OH and WH. Time to blood test results was higher for WH (median 67 min vs. 47 min; P < 0.01), but time to cranial CT scan was similar. Intravenous tPA was administered to 58 (16.4%) OH vs. 26 (13.1%) WH patients (P = 0.33). OH arrival was not associated with poorer outcome (mRS ≥ 3) at discharge (32.8% vs. 37%; P = 0.27), or at the 3-month follow-up (30.6% vs. 27.6%, P = 0.52). No differences were found for in-hospital fatality rates (5.8% vs. 5.4%, P = 1.00).
  
  
  CONCLUSIONS
  The care provided by SC with neurologists on call 24/7 prevents differences in outcomes associated with time of admission and guarantees equal attention to stroke patients.
authors.affiliation: Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain.
authors.forename: M M
authors.initials: MM
authors.lastname: Martínez-Martínez
authors.forename: J
authors.initials: J
authors.lastname: Fernández-Travieso
authors.forename: B
authors.initials: B
authors.lastname: Fuentes
authors.forename: G
authors.initials: G
authors.lastname: Ruiz-Ares
authors.forename: P
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.forename: R
authors.initials: R
authors.lastname: Cazorla García
authors.forename: L A
authors.initials: LA
authors.lastname: Rodríguez de Antonio
authors.forename: P
authors.initials: P
authors.lastname: Alonso-Singer
authors.forename: J
authors.initials: J
authors.lastname: Oliva-Navarro
authors.forename: E
authors.initials: E
authors.lastname: Díez-Tejedor
mesh_terms: D000368:Aged; D005260:Female; D006757:Hospital Units / Q000592:standards; D006801:Humans; D008297:Male; D009462:Neurology / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010820:Physicians / Q000592:standards; D020521:Stroke; D013997:Time Factors; D000078329:Workforce