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 ¼ 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 ¼ À1.31, 95% confidence interval [CI] ¼ À1.52, À1.10), were less often discharged to inpatient rehabilitation (aOR ¼ 0.39, 95% CI ¼ 0.34, 0.44) and had a greater hazard of death within 180 days (hazard ratio ¼ 1.22, 95% CI ¼ 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.

Variation in clinical care associated with weekend admission and discharge in psychiatric in-patient units: retrospective case-note review

“…Concerns have been raised that the quality of in-patient care that people receive may vary according to the day of the week. 1 Clinical outcomes may be worse among patients who are admitted to 2–7 and discharged from 8 acute hospitals at the weekend compared with those admitted and discharged during the ‘working week’.…”

Factors Associated with Receiving a Discharge Care Plan After Stroke in Australia: A Linked Registry Study

“…Patients who are discharged on a weekend less often receive a care plan at the time of hospital discharge than those discharged during the week, as do those discharged to an aged care facility [ 19 ]. Discharge processes for patients with stroke may be particularly sensitive to resourcing deficits on weekends, as care planning requires interactions between a diverse range of healthcare professionals from the multidisciplinary team.…”

“…An understanding of the factors influencing the receipt of discharge care plans in the acute stroke care setting is necessary to guide improvements to this aspect of recommended care. Prior research on factors associated with discharge care planning after acute stroke has been limited to the investigation of single or few factors [ 16 , 17 , 18 , 19 , 20 , 21 ]. We aimed to comprehensively evaluate patient, clinical and system factors associated with receiving a discharge care plan after acute stroke/TIA in Australia.…”

Outcomes of Common General Surgery Patients Discharged Over Weekends at a Tertiary Care Hospital in Taif, Saudi Arabia

“…A study done by Bell et al reported that patients admitted on weekends with ruptured abdominal aortic aneurysms, acute epiglottitis, and pulmonary embolism are associated with higher in-hospital mortality rates than those who were admitted on weekdays for the same problems [7]. An Australian study done among stroke/transient ischemic attack patients reported that patients discharged on weekends received suboptimal care and had higher long-term mortality compared to those discharged on weekdays [8].…”