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Title: Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study.
Austin Authors: Kilkenny, Monique F;Lannin, Natasha A;Levi, Chris;Faux, Steven G;Dewey, Helen M;Grimley, Rohan;Hill, Kelvin;Grabsch, Brenda;Kim, Joosup;Hand, Peter;Crosby, Vanessa;Gardner, Michele;Rois-Gnecco, Juan;Thijs, Vincent N ;Anderson, Craig S;Donnan, Geoffrey A ;Middleton, Sandy;Cadilhac, Dominique A
Affiliation: La Trobe University, Bundoora, Australia
Royal Melbourne Hospital, Parkville, Australia
Stroke Foundation, Melbourne, Australia
University of Newcastle, Newcastle, Australia
Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
St Vincent's Healthcare (Sydney), Sydney, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
Eastern Health Clinical School, Box Hill, Monash University, Australia
Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia
Australian Catholic University, Sydney, Australia
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
Ipswich Hospital, Ipswich, Australia
Wide Bay Hospital and Health Service, Bundaberg, Australia
Albury-Wodonga Health, Albury, Australia
Issue Date: 2019
Date: 2018-10-22
Publication information: International Journal of Stroke 2019; 14(4): 430-438
Abstract: The quality of stroke care may diminish on weekends. 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. 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. 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. 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.
DOI: 10.1177/1747493018806165
ORCID: 0000-0002-3375-287X
Journal: International Journal of Stroke
PubMed URL: 30346259
Type: Journal Article
Subjects: Weekend
clinical indicators
quality care
transient ischemic attack
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