Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study

Monique F. Kilkenny, Natasha A. Lannin, Chris Levi, Steven G. Faux, Helen M. Dewey, Rohan Grimley, Kelvin Hill, Brenda Grabsch, Joosup Kim, Peter Hand, Vanessa Crosby, Michele Gardner, Juan Rois-Gnecco, Vincent Thijs, Craig S. Anderson, Geoffrey Donnan, Sandy Middleton, Dominique A. Cadilhac, on behalf of the AuSCR Consortium

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Number of pages9
JournalInternational Journal of Stroke
DOIs
Publication statusAccepted/In press - 22 Oct 2018

Keywords

  • clinical indicators
  • outcomes
  • quality care
  • stroke
  • transient ischemic attack
  • weekday
  • Weekend

Cite this

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. ; on behalf of the AuSCR Consortium. / Weekend hospital discharge is associated with suboptimal care and outcomes : An observational Australian Stroke Clinical Registry study. In: International Journal of Stroke. 2018.
@article{5531f321d164410bba8d0b561d905579,
title = "Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study",
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.",
keywords = "clinical indicators, outcomes, quality care, stroke, transient ischemic attack, weekday, Weekend",
author = "Kilkenny, {Monique F.} and Lannin, {Natasha A.} and Chris Levi and Faux, {Steven G.} and Dewey, {Helen M.} and Rohan Grimley and Kelvin Hill and Brenda Grabsch and Joosup Kim and Peter Hand and Vanessa Crosby and Michele Gardner and Juan Rois-Gnecco and Vincent Thijs and Anderson, {Craig S.} and Geoffrey Donnan and Sandy Middleton and Cadilhac, {Dominique A.} and {on behalf of the AuSCR Consortium}",
year = "2018",
month = "10",
day = "22",
doi = "10.1177/1747493018806165",
language = "English",
journal = "International Journal of Stroke",
issn = "1747-4930",
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Kilkenny, MF, Lannin, NA, Levi, C, Faux, SG, Dewey, HM, Grimley, R, Hill, K, Grabsch, B, Kim, J, Hand, P, Crosby, V, Gardner, M, Rois-Gnecco, J, Thijs, V, Anderson, CS, Donnan, G, Middleton, S, Cadilhac, DA & on behalf of the AuSCR Consortium 2018, 'Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study' International Journal of Stroke. https://doi.org/10.1177/1747493018806165

Weekend hospital discharge is associated with suboptimal care and outcomes : An observational Australian Stroke Clinical Registry study. / 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.; on behalf of the AuSCR Consortium.

In: International Journal of Stroke, 22.10.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Weekend hospital discharge is associated with suboptimal care and outcomes

T2 - An observational Australian Stroke Clinical Registry study

AU - Kilkenny, Monique F.

AU - Lannin, Natasha A.

AU - Levi, Chris

AU - Faux, Steven G.

AU - Dewey, Helen M.

AU - Grimley, Rohan

AU - Hill, Kelvin

AU - Grabsch, Brenda

AU - Kim, Joosup

AU - Hand, Peter

AU - Crosby, Vanessa

AU - Gardner, Michele

AU - Rois-Gnecco, Juan

AU - Thijs, Vincent

AU - Anderson, Craig S.

AU - Donnan, Geoffrey

AU - Middleton, Sandy

AU - Cadilhac, Dominique A.

AU - on behalf of the AuSCR Consortium

PY - 2018/10/22

Y1 - 2018/10/22

N2 - 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.

AB - 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.

KW - clinical indicators

KW - outcomes

KW - quality care

KW - stroke

KW - transient ischemic attack

KW - weekday

KW - Weekend

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U2 - 10.1177/1747493018806165

DO - 10.1177/1747493018806165

M3 - Article

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

ER -