title: A stroke care management system prevents outcome differences related to time of stroke unit admission.
abstract: BACKGROUND
  Evidence supports that admitting patients with stroke during different hospital work periods is related to distinct outcomes. We aimed to analyse outcomes in patients according to the period and time of admission to the stroke unit.
  
  
  METHODS
  Retrospective study. For purposes of data analysis, patients were grouped according to the following time periods: a) day of the week, b) period of the year, c) shift. We analysed demographic characteristics, stroke type and severity, and the percentage undergoing thrombolysis in each group. The measures used to evaluate early outcomes were the National Institutes of Health Stroke Scale (NIHSS), neurological complications (NC), and in-hospital mortality. Functional outcome at 3 months was determined using the modified Rankin scale.
  
  
  RESULTS
  The stroke unit admitted 1250 patients. We found NC to be slightly more frequent for weekend admissions than for weekday admissions, but this trend does not seem to have influenced in-hospital mortality. Regarding functional outcome at 3 months, 67.0% of weekday vs. 60.7% of weekend admissions were independent (P=.096), as were 65.5% of patients admitted during the academic months vs. 63.5% of those admitted during summer holidays (P=.803). We identified no significant differences in 3-month mortality linked to the day or period of admission; however, for the variable 'shift', 13.2% of the patients died during the morning shift, 11.5% during the afternoon shift, and 6.0% during the night shift (P=.017). We identified a trend toward higher rates of thrombolysis administration on weekdays, during the morning shift, and during the academic months.
  
  
  CONCLUSIONS
  Time of admission to the stroke unit did not affect early outcomes or functional independence at 3 months.
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: R
authors.initials: R
authors.lastname: Romero Sevilla
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Portilla Cuenca
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: F
authors.initials: F
authors.lastname: López Espuela
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: I
authors.initials: I
authors.lastname: Redondo Peñas
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: I
authors.initials: I
authors.lastname: Bragado Trigo
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: B
authors.initials: B
authors.lastname: Yerga Lorenzana
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: M
authors.initials: M
authors.lastname: Calle Escobar
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: M
authors.initials: M
authors.lastname: Gómez Gutiérrez
authors.affiliation: Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España. Electronic address: icasadon@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Casado Naranjo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute stroke; Admission; Fin de semana; Ictus agudo; Ingreso; Outcome; Pronóstico; Stroke unit; Thrombolysis; Trombólisis; Unidad de ictus; Weekend