UK stroke care also suffers over the weekend
NEW YORK |
NEW YORK (Reuters Health) - A new study from England provides more evidence that stroke patients don't fare as well when they're hospitalized over the weekend. The findings - which show fewer patients admitted on Saturday or Sunday ended up back at home after a stroke, and more died - are consistent with trends in hospitals in Canada and the United States.
William Palmer, a PhD student at Imperial College London who led the new study, said worse weekend care and outcomes are probably due to less organization and staffing on off-days. "Not having a (brain) scanning machine open, for example, or not having a specialist consultant actually on the wards - those are probably key differences on the weekend," Palmer told Reuters Health.
"There are certainly fewer staff on weekends. If there is an emergency, the staff that's there is going to be more pushed."
Over the year-long study, the researchers calculated that about 350 stroke-related deaths could have been prevented if weekend care was up to par with weekday care. And another 650 patients could have been discharged to their home or previous place of residence within two months of the stroke, Palmer and his colleagues wrote Monday in the Archives of Neurology.
The results come from data on close to 94,000 patients hospitalized for a stroke at public hospitals in England, one-quarter of whom were admitted on the weekend. Based on National Health Service records, the researchers found treatments and outcomes were consistently slightly better for people who showed up after a stroke on a weekday.
For example, 47.6 percent of weekday-treated stroke patients had a brain scan the day they came in, as recommended, compared to 43.1 percent of weekend-treated patients. Just under nine percent of patients admitted Monday through Friday died within a week in the hospital, compared to 10.6 percent of those who arrived on a Saturday or Sunday.
Those findings held up after the researchers took into account patients' age, type of stroke and other medical conditions. But Palmer and his colleagues only had limited information on the severity of strokes, they noted - which could have affected how many patients died or ended up needing long-term care. Every year, about 150,000 people in the UK and 800,000 in the U.S. have a stroke.
Although other studies have shown a similar pattern of weekday-weekend differences, one report specifically on designated "comprehensive stroke centers" - which have certain specialists and services available around the clock - showed care at those facilities wasn't any worse on the weekend (see Reuters Health story of September 14, 2011.)
Palmer said London is experimenting with designating stroke centers as well, and has seen positive initial results.
"Comprehensive stroke centers that maintain adequate staffing with stroke experts on weekends mitigate this ‘weekend effect' and provide quality care regardless of the day of the week," said Dr. James McKinney, medical director of the Robert Wood Johnson University Hospital Comprehensive Stroke Center in New Brunswick, New Jersey.
"This study reinforces the need for stroke patients to be admitted to dedicated stroke centers," McKinney, who wasn't involved in the new research, told Reuters Health in an email. "People should know what hospitals in their community are stroke centers, and in the event they or their family members suffer a stroke request to be taken to a stroke center."
Stroke centers could be one of the answers to lacking weekend care in cities, Palmer agreed - but he said getting stroke patients to quality care quickly in rural areas may be a different challenge.
SOURCE: bit.ly/LLObFd Archives of Neurology, online July 9, 2012.
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