title: Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care.
abstract: OBJECTIVE
  To examine the association between day of admission and measures of the quality and safety of the care received by patients with stroke.
  
  
  METHODS
  Retrospective cohort study of patients admitted to hospitals with stroke (codes I60-I64 from the International Statistical Classification of Diseases and Related Health Problems, Tenth Version) from April 1, 2009, through March 31, 2010.
  
  
  METHODS
  English National Health Service public hospitals.
  
  
  METHODS
  PATIENTS during the study period accounted for 93 621 admissions. We used logistic regression to adjust the outcome measures for case mix.
  
  
  METHODS
  Quality and safety measurements using 6 indicators spanning the hospital care pathway, from timely brain scans to emergency readmissions after discharge.
  
  
  RESULTS
  Performance across 5 of the 6 measures was significantly lower on weekends (confidence level, 99%). One of the largest disparities was seen in rates of same-day brain scans, which were 43.1% on weekends compared with 47.6% on weekdays (unadjusted odds ratio, 0.83 [95% CI, 0.81-0.86]). In particular, the rate of 7-day in-hospital mortality for Sunday admissions was 11.0% (adjusted odds ratio, 1.26 [95% CI, 1.16-1.37], with Monday used as a reference) compared with a mean of 8.9% for weekday admissions.
  
  
  CONCLUSIONS
  Strong evidence suggests that, nationally, stroke patients admitted on weekends are less likely to receive urgent treatments and have worse outcomes across a range of indicators. Although we adjusted the results for case mix, we cannot rule out some of the effect being due to unmeasured differences in patients admitted on weekends compared with weekdays. The findings suggest that approximately 350 in-hospital deaths each year within 7 days are potentially avoidable, and an additional 650 people could be discharged to their usual place of residence within 56 days if the performance seen on weekdays was replicated on weekends.
authors: Dr Foster Unit, Imperial College, London, England. w.palmer07@imperial.ac.uk
authors: William L
authors: WL
authors: Palmer
authors: Alex
authors: A
authors: Bottle
authors: Charlie
authors: C
authors: Davie
authors: Charles A
authors: CA
authors: Vincent
authors: Paul
authors: P
authors: Aylin
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data; D000368:Aged; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D004739:England; D005260:Female; D006296:Health Services; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy