The weekend effect for stroke patients admitted to intensive care: A retrospective cohort analysis

Abstract

Objectives To examine the effect of weekend admission on short and long-term morbidity and mortality, for patients admitted to intensive care after suffering a cerebrovascular accident (stroke). Design, setting, and participants A hospital-wide, retrospective cohort study of 3,729 adult stroke patients admitted to the Beth Israel Deaconess Medical Centre (BIDMC) intensive care unit (ICU) between 2001 and 2012, using the Medical Information Mart for Intensive Care III (MIMIC-III) database. Primary outcome measures Primary outcome measures were ICU length-of-stay and mortality, hospital length-of-stay and mortality, proportions of patients discharged home after admission, and 6-month mortality. Results Overall, 23% of BIDMC ICU stroke admissions occurred over the weekend. Those admitted over the weekend were likelier to have suffered haemorrhagic stroke than those admitted during the week (60.6% vs 47.9%). Those admitted on the weekend were younger, and likelier to be male and unmarried, with similar ethnic representation. The OASIS severity of illness (32.5 vs. 32) and lowest day-one GCS (12.6 vs. 12.9) were similar between groups. Unadjusted ICU-mortality was significantly higher for patients admitted over the weekend (OR 1.32, CI 1.08-1.61), but when adjusted for type of stroke, became non-significant (OR 1.17, CI 0.95-1.44). In-hospital mortality was significantly higher for patients admitted to ICU over the weekend in both unadjusted (OR 1.45, CI 1.22-1.73) and adjusted (OR 1.31, CI 1.09-1.58) analyses. There was no significant difference in ICU or hospital length of stay.

Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study

“…16,25,26 Additional subpopulations studies of critically-ill patients (eg, surgical ICUs, cardiac ICUs, and patients with strokes) have also found suggestions of a weekend effect. 15,16,18,19,25,26 The findings of our study are particularly unanticipated given the focus on patients receiving MV, a fundamentally sicker population than has been previously studied and one that may be more vulnerable to potential fluctuations in hospital resources on weekends (eg, respiratory therapy or nurse staffing).…”

“…However, studies have shown mixed results with several demonstrating increased mortality in weekend ICU admissions, possibly mediated by care complications such as delays to ICU bed placement, health care associated pneumonia (HAP), and reintubation. [15][16][17][18][19][20] Conversely, other studies have not shown an association. [21][22][23] These varied results are reflected in systematic reviews and metaanalyses arriving at mixed conclusions that, in aggregate, may suggest a modest weekend effect.…”

Weekend effect on 30-day mortality for ischemic and hemorrhagic stroke analyzed using severity index and staffing level

“…One study suggested factors related to service provision inside and outside the hospital and case-mix factors that may contribute to or modify the weekend effect [ 11 ]. In-hospital factors include lower staffing levels during weekends [ 2 ], delayed assessment and management, fewer ward rounds [ 12 ], and disparities in resources and expertise [ 3 ]. Pre-hospital factors include the timeliness of patient referral and the availability of ambulance service [ 11 ].…”