Monique F Kilkenny1,2, Natasha A Lannin3, Chris Levi4, Steven G Faux5, Helen M Dewey2,6, Rohan Grimley1,7, Kelvin Hill8, Brenda Grabsch2, Joosup Kim1,2, Peter Hand9, Vanessa Crosby10, Michele Gardner11, Juan Rois-Gnecco12, Vincent Thijs2,13, Craig S Anderson14, Geoffrey Donnan2, Sandy Middleton5,15, Dominique A Cadilhac1,2. 1. 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia. 2. 2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia. 3. 3 La Trobe University, Bundoora, Australia. 4. 4 University of Newcastle, Newcastle, Australia. 5. 5 St Vincent's Healthcare (Sydney), Sydney, Australia. 6. 6 Eastern Health Clinical School, Box Hill, Monash University, Australia. 7. 7 Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia. 8. 8 Stroke Foundation, Melbourne, Australia. 9. 9 Royal Melbourne Hospital, Parkville, Australia. 10. 10 Albury-Wodonga Health, Albury, Australia. 11. 11 Wide Bay Hospital and Health Service, Bundaberg, Australia. 12. 12 Ipswich Hospital, Ipswich, Australia. 13. 13 Austin Health, Heidelberg, Australia. 14. 14 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia. 15. 15 Australian Catholic University, Sydney, Australia.
Abstract
BACKGROUND: The quality of stroke care may diminish on weekends. AIMS: We aimed to compare the quality of care and outcomes for patients with stroke/transient ischemic attack discharged on weekdays compared with those discharged on weekends. METHODS: Data from the Australian Stroke Clinical Registry from January 2010 to December 2015 (n = 45 hospitals) were analyzed. Differences in processes of care by the timing of discharge are described. Multilevel regression and survival analyses (up to 180 days postevent) were undertaken. RESULTS: Among 30,649 registrants, 2621 (8.6%) were discharged on weekends (55% male; median age 74 years). Compared to those discharged on weekdays, patients discharged on weekends were more often patients with a transient ischemic attack (weekend 35% vs. 19%; p < 0.001) but were less often treated in a stroke unit (69% vs. 81%; p < 0.001), prescribed antihypertensive medication at discharge (65% vs. 71%; p < 0.001) or received a care plan if discharged to the community (47% vs. 53%; p < 0.001). After accounting for patient characteristics and clustering by hospital, patients discharged on weekends had a 1 day shorter length of stay (coefficient = -1.31, 95% confidence interval [CI] = -1.52, -1.10), were less often discharged to inpatient rehabilitation (aOR = 0.39, 95% CI = 0.34, 0.44) and had a greater hazard of death within 180 days (hazard ratio = 1.22, 95% CI = 1.04, 1.42) than those discharged on weekdays. CONCLUSIONS: Patients with stroke/transient ischemic attack discharged on weekends were more likely to receive suboptimal care and have higher long-term mortality. High quality of stroke care should be consistent irrespective of the timing of hospital discharge.
BACKGROUND: The quality of stroke care may diminish on weekends. AIMS: We aimed to compare the quality of care and outcomes for patients with stroke/transient ischemic attack discharged on weekdays compared with those discharged on weekends. METHODS: Data from the Australian Stroke Clinical Registry from January 2010 to December 2015 (n = 45 hospitals) were analyzed. Differences in processes of care by the timing of discharge are described. Multilevel regression and survival analyses (up to 180 days postevent) were undertaken. RESULTS: Among 30,649 registrants, 2621 (8.6%) were discharged on weekends (55% male; median age 74 years). Compared to those discharged on weekdays, patients discharged on weekends were more often patients with a transient ischemic attack (weekend 35% vs. 19%; p < 0.001) but were less often treated in a stroke unit (69% vs. 81%; p < 0.001), prescribed antihypertensive medication at discharge (65% vs. 71%; p < 0.001) or received a care plan if discharged to the community (47% vs. 53%; p < 0.001). After accounting for patient characteristics and clustering by hospital, patients discharged on weekends had a 1 day shorter length of stay (coefficient = -1.31, 95% confidence interval [CI] = -1.52, -1.10), were less often discharged to inpatient rehabilitation (aOR = 0.39, 95% CI = 0.34, 0.44) and had a greater hazard of death within 180 days (hazard ratio = 1.22, 95% CI = 1.04, 1.42) than those discharged on weekdays. CONCLUSIONS:Patients with stroke/transient ischemic attack discharged on weekends were more likely to receive suboptimal care and have higher long-term mortality. High quality of stroke care should be consistent irrespective of the timing of hospital discharge.
Authors: Abeer I Alsulaimani; Khalid M Alzahrani; Khalid M Al Towairgi; Layla M Alkhaldi; Amani H Alrumaym; Zouhor A Alhossaini; Rami F Algethami Journal: Cureus Date: 2022-07-19