1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
Int J Stroke. 2019 Jun;14(4):430-438. doi: 10.1177/1747493018806165. Epub 2018 Oct 22.
The quality of stroke care may diminish on weekends.
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.
Data from the Australian Stroke Clinical Registry from January 2010 to December 2015 ( = 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.
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%; < 0.001) but were less often treated in a stroke unit (69% vs. 81%; < 0.001), prescribed antihypertensive medication at discharge (65% vs. 71%; < 0.001) or received a care plan if discharged to the community (47% vs. 53%; < 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.
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.
周末期间卒中护理质量可能会下降。
我们旨在比较在工作日出院和周末出院的卒中/短暂性脑缺血发作患者的护理质量和结局。
对 2010 年 1 月至 2015 年 12 月（共 45 家医院）澳大利亚卒中临床登记处的数据进行分析。描述了按出院时间的护理流程差异。进行了多水平回归和生存分析（至事件后 180 天）。
在 30649 名登记患者中，2621 名（8.6%）在周末出院（55%为男性；中位年龄 74 岁）。与在工作日出院的患者相比，周末出院的患者更常患有短暂性脑缺血发作（周末为 35%，而 19%； < 0.001），但更常在卒中单元接受治疗（周末为 69%，而 81%； < 0.001），出院时接受降压药物治疗（周末为 65%，而 71%； < 0.001）或出院至社区时接受护理计划（周末为 47%，而 53%； < 0.001）。在考虑患者特征和医院聚类后，周末出院的患者住院时间缩短 1 天（系数=-1.31，95%置信区间[CI]：-1.52，-1.10），出院后更不可能接受住院康复治疗（优势比[aOR]：0.39，95%CI：0.34，0.44），且 180 天内死亡的风险更高（风险比[HR]：1.22，95%CI：1.04，1.42）。
周末出院的卒中/短暂性脑缺血发作患者更可能接受不充分的护理，且长期死亡率更高。无论医院出院时间如何，都应保持高质量的卒中护理。
