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Weekend admission puts stroke patients at risk

Hospitals lack specialist staff and services on Saturday and Sunday

Mark Gould

Tuesday, 10 July 2012

Stroke patients who are hospitalised at weekends are less likely to receive urgent treatments and had worse outcomes, according to a new study.

Studies from other countries have suggested higher mortality in patients who were admitted to the hospital on weekends for a variety of medical conditions, a phenomenon known as "the weekend effect."

However, other studies have not identified an association between the day of admission and mortality rates due to stroke, so the debate over "the weekend effect" continues, according to the study background.

In a report published Online First by Archives of Neurology today, William Palmer from Imperial College and the National Audit Office, and colleagues examined the care of 93,621 stroke patients admitted to NHS hospitals from April 2009 to March 2010.

They examined six indicators including the following process and outcome measures:

  • Brain scan on the day of admission
  • Thrombolysis treatment
  • Diagnosis of aspiration pneumonia (a complication) in the hospital
  • Seven-day in-hospital mortality
  • Discharge to usual place of residence within 56 days; and
  • Thirty-day emergency readmission (all causes).

Performance across five of six measures was lower on weekends, with one of the largest disparities seen in rates of same-day brain scans (43.1 % on weekends compared with 47.6 % on weekdays).

Also, the rate of seven-day, in-hospital mortality for Sunday admissions was 11% compared with a mean (average) of 8.9% for weekday admissions, according to study results.

The authors conclude:

"We calculated that approximately 350 potentially avoidable in-hospital deaths occur within seven days each year and that 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.”

And they add that the present study is unique in providing a “comprehensive and current assessment” of the degree to which the quality and safety of stroke care are affected by whether a patient is admitted during the weekend.

“The study uses national routine hospital admissions data and thereby highlights the potential for identifying clinically important issues using this readily available resource.”

The results have significant implications; in the NHS in England, stroke is the largest cause of adult disability and costs £3 billion a year for direct care. Several possible explanations for these findings include fewer clinical staff working in hospitals on weekends, with those who do work often having less experience and lower familiarity with the patients; less accessibility of resources such as radiologists to operate the scanners; and higher-severity strokes among patients admitted at weekends.

This study provides some evidence to support previous findings that contributing factors might include a decreased proportion of stroke patients on weekends being admitted under the responsibility of stroke specialists or having access to fast-track discharge pathways.

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