Off-hour effects on stroke care and outcome in stroke centres

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Acute stroke patients admitted during off-hours and weekends historically experience poorer care and outcomes.
• Specialized Stroke Centres (SC) aim to provide continuous, high-quality care irrespective of admission timing.

Purpose of the Study:

• To compare the specialized care processes and patient outcomes for acute stroke patients admitted to Stroke Centres during work hours versus off-hours.
• To evaluate if continuous specialized stroke care mitigates outcome disparities based on admission time.

Main Methods:

• An observational study analyzed consecutive stroke patients admitted to SCs in 2008-2009.
• Patients were categorized into Work Hours (WH) and Off-Hour (OH) groups based on admission time.
• Key metrics included time to diagnostics, tPA administration, modified Rankin Scale (mRS) for outcome, and in-hospital fatality.

Main Results:

• Of 674 analyzed patients, 64.4% arrived during OH. No significant differences in stroke severity were observed between WH and OH groups.
• While time to blood test results was longer for WH, cranial CT scan times were similar.
• Intravenous tPA administration rates, discharge and 3-month mRS scores, and in-hospital fatality rates showed no significant differences between OH and WH groups.

Conclusions:

• Stroke Centres providing 24/7 neurologist coverage effectively prevent outcome disparities related to admission time.
• Continuous specialized stroke care ensures equitable treatment and outcomes for all acute stroke patients, regardless of when they arrive.