Off-Hours Admission and Acute Stroke Care Quality

Kristiansen, Nina Sahlertz; Mainz, Jan; Nørgård, Bente Mertz; Bartels, Paul; Andersen, Grethe

doi:10.1161/strokeaha.114.005535

Cited by 19 publications

(2 citation statements)

References 31 publications

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“…[2,12,29–34] However, the effect of weekend or off-hour admission on mortality has been negated after adjustment for stroke severity as assessed by using a stroke scale or a similar proxy, [4,9,10,28,35,36] as seen in the present study. The present analysis also found that the effect of brain surgery on mortality turned from harmful to null after adjustment for stroke severity.…”

Section: Discussionmentioning

confidence: 53%

“Weekend effect” on stroke mortality revisited

et al. 2016

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Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P < 0.001) and stroke severity index (7.8 vs 7.4, P < 0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08–1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95–1.20).The “weekend effect” on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.

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Section: Discussionmentioning

confidence: 53%

“Weekend effect” on stroke mortality revisited

et al. 2016

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“…A recent study of stroke care in the Denmark (using the Danish Stroke Registry) found that patients admitted during off-hours showed a lower degree of compliance with 8 out of 10 performance measures between 2003 and 2011 [ 26 ]. In contrast, our study showed that patients admitted during off-hours did not receive a poorer quality of care between 2007 and 2008 in the CNSR database.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Off-Hour Emergency Care in Acute Ischemic Stroke: Results from the China National Stroke Registry

Gui-fen¹,

Liu²,

Zhang³

et al. 2015

PLoS ONE

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Background and PurposeThe quality of after-hour emergency care of patients with acute ischemic stroke is debatable. We therefore, sought to analyze the performance measures, quality of care and clinical outcomes in these patients admitted during off-hours.MethodsOur study included 4493 patients from a selected cohort of patients admitted to the hospitals with ischemic stroke in the China National Stroke Registry (CNSR) from September 2007 to August 2008. On-hour presentation was defined as arrival at the emergency department from the scene between 8AM and 5PM from Monday through Friday. Off-hours included the remainder of the on-hours and statutory holidays. The association between off-hour presentation and outcome was analyzed using multivariate logistic-regression models.ResultsOff-hour presentation was identified in 2672 (59.5%) patients with ischemic stroke. Comparison of patients admitted during off-hours with those admitted during on-hours revealed an unadjusted odds ratio of in-hospital mortality of 1.38 (95% confidence interval, 1.04–1.85), which declined to 1.34 (95% confidence interval, 0.93–1.93) after adjusting for patient characteristics (especially, pre-hospital delay). No difference in 30-day mortality, total death or dependence at three, six and 12 months between two groups was observed. No association between off-hour admission and quality of care was found.ConclusionsIn the CNSR database, compared with on-hour patients, off-hour patients with acute ischemic stroke admitted to the emergency departments from scene manifested a higher incidence of in-hospital mortality. However, the difference in incidence and quality of care between the groups disappeared after adjusting for pre-hospital delay and other variables.

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