Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study. Academic Article uri icon

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.

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

publication date

  • 2019