High cost of ‘weekend effect’ in stroke care

By Eleanor McDermid

Weekend admission adversely affects a range of quality and safety indicators of acute stroke care, report UK researchers.

"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," say William Palmer (Imperial College London) and colleagues.

Although the findings are in line with those of other studies, these previous studies, "focus primarily on short-term mortality and therefore do not capture wider aspects of the quality and safety of care," they write in the Archives of Neurology.

The team assessed six indicators of care and outcomes for 93,621 stroke patients admitted to English hospitals from April 2009 through March 2010, finding that only the rate of emergency admissions within 30 days was unaffected by whether patients were admitted at the weekend or during the week.

Weekend admission affected two measures of quality care, reducing the proportion of brain scans undertaken within 24 hours to 42.6%, down from 47.8% during the week, and reducing thrombolysis use to 2.2%, down from 2.7%. These values were adjusted for variables including age, gender, comorbidities, and stroke subtype.

Patients were more likely to develop a complication - aspiration pneumonia - if they were admitted at the weekend, rather than during the week, at 5.6% versus 5.1%. As in previous research, 7-day in-hospital mortality was significantly higher if patients were admitted at the weekend, at 10.3% versus 9.0% for weekday admissions.

Weekend admission also appeared to reduce patients' chances for being discharged to their usual place of residence within 56 days. This occurred for 71.3% of patients admitted at the weekend, compared with 72.9% of those admitted during the week.

Palmer et al say that, based on these findings, bringing the standard of weekend stroke care in England up to that seen during the week could reduce the annual number of in-hospital stroke deaths by 350 and increase the number of patients discharged to their usual place of residence by 650.

The researchers caution that they could not account for some measures of stroke severity that may have contributed to the weekend effect. Indeed, a previous study suggested that the weekend effect could be an artifact caused by patients with mild symptoms waiting until Monday to seek healthcare.

"However, some of the measures that reveal a significant disparity, particularly same-day brain scan rates, are less likely to be affected by variations in stroke severity," say Palmer and team.

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