Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study. Issue 4 (June 2019)

• Record Type: Journal Article
• 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; Anderson, Craig S; Donnan, Geoffrey; Middleton, Sandy; Cadilhac, Dominique A
• Is Part Of: International journal of stroke. Volume 14:Issue 4(2019)
• Page Start: 430
• Page End: 438
• Publication Date: 2019-06
• Subjects: Weekend -- weekday -- quality care -- clinical indicators -- outcomes -- stroke -- transient ischemic attack; 616.8005
• DOI: 10.1177/1747493018806165
• Languages: English
• ISSNs: 1747-4930

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.