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Quality of Stroke Care Varies by Day and Time of Hospital Visit

CardioSmart News

The timing of hospital admission may have a real impact on stroke treatment, according to a recent study that found significant fluctuation in the quality of stroke care depending on when one is admitted.

Published in The Lancet, this study investigated the so-called weekend and off-hours effects, which imply hospitals deliver poorer quality of care during weekends and overnight than on weekdays. These trends were first identified in the 1970s, when studies reported higher mortality rates for babies born on weekends than during the week in the USA, UK and Australia. Since then, studies have found similar associations for other outcomes and quality of care, gaining much attention in the news and media.

To further investigate, researchers analyzed data from the Sentinel Stroke National Audit Programme—the national registry of stroke care in England and Wales. The study included more than 74,000 adults admitted for stroke between 2013 and 2014 across 199 hospitals.

Overall, researchers found that treatment quality for stroke varied across the entire week, not just on weekends. Patients admitted at night were less likely to receive 8 of the 12 interventions recommended by guidelines, such as receiving a brain scan within one hour of hospital arrival. Patients admitted on the weekend were also less likely to receive quality care based on clinical standards.

However, we should be more concerned about patients admitted at night than on weekends, based on study findings. Stroke patients admitted at night had a 10% higher mortality rate after 30 days than those admitted during the day. In comparison, there was no significant difference in 30-day mortality rates between patients admitted on weekdays versus the weekend.

Based on findings, authors conclude that the “weekend effect” is an oversimplification of patterns when it comes to stroke care. While treatment quality and outcomes vary throughout the week, the weekend is not the only factor driving trends. Thus, authors highlight the need to address variation in quality of care across the board, rather than on weekends alone. Adherence to treatment guidelines can help significantly improve outcomes for patients affected by stroke. Authors argue that the more closely we adhere to those guidelines, the better stroke outcomes will be.

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