Weekend Discharge and Stroke Quality of Care: Get With The Guidelines-Stroke Data from a Comprehensive Stroke Center.
OBJECTIVE
Get With The Guidelines-Stroke collects data on hospital compliance with evidence-based stroke quality of care indicators. Prior work has investigated a link between weekend hospital admission and increased mortality after stroke. There is, however, a paucity of work investigating a similar association between weekend hospital discharge and quality of care. We aimed to determine if weekend discharge affects care to enlighten opportunities for quality improvement.


METHODS
Through a retrospective analysis of records from a Comprehensive Stroke Center from July 2010 to June 2015, we identified patients with ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage. Our quality of care indicators were dysphagia screening, rehabilitation assessment, smoking cessation counseling, stroke education, and weight reduction counseling. We created regression models to find adjusted differences in quality of care measure compliance for patients discharged on the weekend.


RESULTS
Our analysis included 2737 patients, of which 431 were discharged on the weekend. After adjustment, weekend discharge was significantly associated with reduced stroke education (odds ratio .67, confidence interval .51-0.88, P = .004) and reduced weight reduction counseling (odds ratio .65, confidence interval .45-0.93, P = .018).


CONCLUSIONS
Hospital discharge on the weekend was associated with an adjusted one-third decrease in odds of stroke education and weight reduction counseling. There is an opportunity for quality improvement in educating stroke patients before hospital discharge on the weekend.
Department of Anesthesiology and Pain Medicine, University of Washington Seattle, Washington. Electronic address: starrj@uw.edu.
Jordan B
JB
Starr
Department of Neurology, University of Washington, Seattle, Washington.
Kyra J
KJ
Becker
Department of Neurology, University of Washington, Seattle, Washington.
David L
DL
Tirschwell
D039602:After-Hours Care / Q000592:standards*; D000368:Aged; D016009:Chi-Square Distribution; D003376:Counseling / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D017064:Process Assessment, Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome; D014861:Washington; D015431:Weight Loss
Stroke; database; health education; quality improvement