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Patients & Public > Research using SSNAP data > Plain English Summaries > How does quality of stroke care vary over the week?

Lay summary: How does quality of stroke care vary over the week? Moving beyond the 'weekend effect' to describe variation in stroke care quality.

The ‘weekend effect’ is where patients who are admitted to hospital on the weekend receive poorer quality of care and have worse outcomes than patients admitted on weekdays. This 2016 study revealed that patterns of stroke care are much more complex than the ‘weekend effect’.

Using data from over 74,000 patients, four more complex patterns of stroke care were identified:

1) Quality of care was worse at night compared to during the daytime. 

At night, a smaller percentage of patients were given a clot-dissolving drug, tested for difficulty with swallowing, or given a brain scan within 1 hour (or 12 hours) of arriving at the hospital.

2) Quality of care varied depending on the day of the week. 

On certain days, a smaller proportion of patients were assessed by a doctor or nurse specialised in stroke care, and a smaller proportion of patients had their communication and ability to swallow assessed by a speech and language therapist (SALT). The amount of physiotherapy or occupational therapy patients received also varied depending on the day of the week.

3) Care was worse outside of daytime working hours.

Patients who arrived at the hospital outside of daytime working hours experienced longer time taken to receive a blood-clot dissolving drug. Patients who were admitted overnight on weekdays had lower odds of survival than patients admitted during the day.

4) Care quality also varied across several days. 

For example, the number of patients admitted to a stroke unit (specialised hospital ward for stroke patients) within 4 hours of arriving at the hospital increased for several days then decreased for several days.

Why does care quality vary over the week?

There are many factors that contribute to this variation in stroke care.

For example, social services cannot start personal care services at weekends. If a care plan is not started, patients cannot be discharged, and the stroke unit will be unable to take new admissions on the weekend.

Furthermore, hospitals are more sparsely staffed at night so it is not surprising that processes of care are slower. Access to brain scans is more difficult at night.

What does this study tell us?

This study shows that despite improvements in overall care over the past decade, the quality of care that patients receive is still at least partly dependent on the time of day or day of the week they have their stroke. If inequalities in care are to be overcome, and they must be, health and social services need to truly develop seven day services that provide the same quality of care outside of daytime working hours (including at night and on the weekend).

About the paper:
Paper title: 'Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care.'
Year published: 2016
Authors: Benjamin Bray, Geffrey C Cloud, Martin A James, Harry Hemingway, Lizz Paley, Kevin Steward, Pippa J Tyrell, Charles D A Wolfe, Anthony G Rudd, the SSNAP Collaboration.

A summary of this paper was published in the article '20 years of researching stroke through audit'.
You can view the full paper here.
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