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


OBJECTIVE
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.
Division of Applied Medicine, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK.
Melanie
M
Turner
Stroke Unit, Monklands General Hospital, Airdrie, UK.
Mark
M
Barber
Information Services Division, NHS National Services Scotland, Edinburgh, UK.
Hazel
H
Dodds
Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.
Martin
M
Dennis
Academic Section of Geriatric Medicine, University of Glasgow, Royal Infirmary, Glasgow, UK.
Peter
P
Langhorne
Division of Applied Medicine, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK.
Mary-Joan
MJ
Macleod
D000368:Aged; D015331:Cohort Studies; D003679:Deglutition; D005260:Female; D017408:Guidelines as Topic; D006693:Holidays; D006801:Humans; D007902:Length of Stay; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome