Stroke Rounds: Does Severity Drive the Weekend Effect?

If we look objectively at what the problem is with weekend stroke care it is that too much subjective specialized knowledge is needed. The solution is to rely on objective measures that will diagnose a stroke like the Star Trek-style 'tricorder' invention offered $10m prize or One of these 17 ways still need to be be proven for fast and objective diagnosis. And if there were written stroke protocols we could evaluate their effectiveness rather than relying on seat-of-the-pants stroke interventions. But I know nothing since I am not medically trained.
http://www.medpagetoday.com/Cardiology/Strokes/48519?xid=nl_mpt_cardiodaily_2014-11-11&

The mortality impact of off-hours admission for stroke appeared to be largely related to severity, as quality of night and weekend care improved, a Danish study suggested.
Overall, death within 30 days was 15% more common among patients presenting to Danish hospitals on weekend, evening, or night-time hours compared with those admitted during regular business hours, Nina Sahlertz Kristiansen, MHSc, of the Centre for Quality in Middelfart, Denmark, and colleagues found.
Off-hours admissions were associated with a lower likelihood of meeting even eight out of 10 performance measures, but that difference diminished over time, particularly from 2003 to 2011 after a national quality improvement program, the group reported online in Stroke.
The key factor in the mortality difference appeared to be stroke severity, they noted.
Adjustment for patient characteristics -- "in particular, stroke severity" -- decreased the odds of 30-day case fatality to 1.03 (95% CI 0.97-1.10), whereas additional adjustment for hospital characteristics and compliance with performance measures had no effect.
The population-based Danish Stroke Registry study included 64,975 patients admitted to Danish hospitals with a first-ever acute stroke from Jan. 1, 2003 through Dec. 31, 2011 and used national healthcare records to determine outcome.
Among these patients, 39,072 were admitted on the weekend (Friday, 11 p.m. to Monday, 6:59 a.m.) or during evenings and night-time shifts on weekdays (3 p.m. to 7 a.m.).
"During the study period, 7 a.m. to 3 p.m. was the only time during the day where the units in general were fully staffed, with the different healthcare professionals required in modern interdisciplinary stroke care," the researchers noted. "Outside this time frame, the nurse ratio was typically lower and the access to occupational therapists and physiotherapists restricted."
The overall quality of care by a composite performance measure was an absolute 11.8% poorer among patients admitted off-hours (adjusted relative risk 0.73, 95% CI 0.69-0.76).
Stroke severity didn't appear to account for that difference, based on adjusted risk, the researchers noted.
Rather, the "in general modest ... variation in care was substantially reduced after implementation of a national systematic quality improvement program," they noted.