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Dying for the Weekend – Association Between Day of Hospital Presentation and the Quality and Safety of Stroke Care


Sickness knows not the time of day or the day of the week.


According to an article published in the Archives of Neurology (2012;69:1296-1302), a study was performed to examine the association between day of admission and measures of the quality and safety of the care received by patients with stroke.


The investigation was a retrospective cohort study of patients admitted to English National Health Service public hospitals with stroke (codes I60-I64 from the International Statistical Classification of Diseases and Related Health Problems, Tenth Version) from April 1, 2009, through March 31, 2010. The main outcome measures were quality and safety measurements using 6 indicators spanning the hospital care pathway, from timely brain scans to emergency readmissions after discharge.


There were 93,621 admissions during the study period. Performance across 5 of the 6 measures was significantly lower on weekends (confidence level, 99%). One of the largest disparities was seen in rates of same-day brain scans, which were 43.1% on weekends compared with 47.6% on weekdays. In particular, the rate of 7-day in-hospital mortality for Sunday admissions was 11.0% (with Monday used as a reference) compared with a mean of 8.9% for weekday admissions.


According to the authors, strong evidence suggests that, nationally, stroke patients admitted on weekends are less likely to receive urgent treatments and have worse outcomes across a range of indicators. The authors assed that although the results were adjusted for case mix, it was not possible to rule out some of the effect being due to unmeasured differences in patients admitted on weekends compared with weekdays. The findings suggest that approximately 350 in-hospital deaths each year within 7 days are potentially avoidable, and 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.


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