More Stroke Patients Die After Weekend Hospital Admissions

PHOTO: Previous studies suggest poorer outcomes for patients with strokes hospitalized on weekends.
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Patients who are hospitalized over the weekend for strokes fare worse than those who come into the hospital during the week, according to new UK research published in the Archives of Neurology.

The study found patients who were hospitalized on the weekends for stroke were less likely to receive urgent treatments and had overal worse outcomes. Dubbed "the weekend effect," other studies, including those conducted in the U.S., have shown similar results with a variety of medical conditions, but none have specifically looked at admission days and their effect on mortality rates after stroke, according to the research.

"The scale of the issue is substantial, with approximately 350 potentially avoidable in-hospital deaths within seven days, and an additional 650 people could be discharged to their usual place of residence," said Will Palmer of the Imperial College and the National Audit Office in England, and lead author of the study.

Palmer noted that the results are representative of a population that is one-sixth the size of the United States.

"The results are consistent with previous studies in the U.S., which have suggested a weekend effect in stroke care," said Palmer. "However, to date, there has not been such a comprehensive study in the U.S."

The study included more than 90,000 UK patients over a one-year period in 2009. Researchers analyzed the day in which a person was admitted for stroke and compared six indicators of stroke care, including the availability of brain scans and clot treatments, 30-day readmission rates, complications, seven-day mortality and hospital discharge.

Researchers found that there was an 11 percent in-hospital death rate for Sunday admissions, compared to an average of 8.9 during the weekdays. The availability of same-day brain scans showed the largest disparity, with 43.1 percent on the weekends, compared to 47.6 percent on weekdays.

They also found that strokes which occurred over the weekend were also more likely to be classified as emergencies than those during the week. Of note, emergency readmission rates within 30 days did not differ between weekend versus mid-week patients.

The scientists suggested that a lack of staff, particularly among specialty staff, along with lack of access to urgent treatments, are responsible for the weekend outcomes, but these are are areas that can be addressed "through better management of the existing resources and, where necessary, some additional investment," said Palmer.

Every year, about 795,000 people in the United States have a stroke, according to the CDC, and someone dies from a stroke every four minutes.

"The study provides some evidence to suggest organizational factors, such as the availability of specialist staff and access to urgent treatments such as brain scans and thrombolysis, are responsible for the worse outcomes," said Palmer. "These are all areas that can be addressed through better management of the existing resources, and where necessary, some additional investment."

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