Associations between Stroke Mortality and Weekend Working by Stroke Specialist Physicians and Registered Nurses: Prospective Multicentre Cohort Study

Abstract

In a multicenter observational study, Benjamin Bray and colleagues evaluate whether weekend rounds by stroke specialist physicians, or the ratio of registered nurses to beds on weekends, is associated with patient mortality after stroke. Please see later in the article for the Editors' Summary

Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care

“…19,20,21 These differences might be explained by differences in how stroke care services are organised 21 , and there is evidence that low nurse staffing levels on stroke units are associated with higher mortality at weekends. 22 The limitation of much of the previous literature on the "weekend effect" is that it has typically been based on comparisons of weekends versus weekdays, or regular versus off-hours, without taking into account variation that might occur across both day of the week and time of day. There are however a small number of studies that have considered how care might vary in this way.…”

Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals

“…Previous patient-level studies have shown that ischemic stroke mortality risk increased as the nurse to patient ratio increased because better staffing allows nurses to provide higher quality care, while also allowing for quicker responses to stroke complications and lower mortality. 29,30 Hospitals with greater specialist services, such as Joint Commission-certified primary stroke centers and noncritical access hospitals, have been shown to have significantly lower risk-standardized mortality rates for ischemic stroke. [31][32][33] In contrast, we also found that an increase in the number of neurologists in an HRR was associated with increased 30-day readmission rates.…”

The latest national clinical guideline for stroke

“…6 The evidence for other professions is not so robust but the ICSWP felt that it was important to make recommendations to support service development, as shown in Table 1 .…”