Stroke victims are 12 per cent more likely to die within seven days if they arrive at the hospital on the weekend, according to a study of more than 20,000 Ontario patients.
The study, published today in Neurology, found that patients received the same major interventions — brain scans, clot-busting medications and admission to stroke units — regardless of when they were admitted.
Dr. Moira Kapral, a researcher at the Institute for Clinical Evaluative Sciences and one of the study’s authors, says it is possible that the weekend effect is caused by “an accumulation of small deficiencies in care” — including secondary treatment that is nonetheless crucial for recovery.
For example, she says, there might be fewer or less-experienced staff working on the weekends. Or patients might experience delays in access to rehabilitation experts, such as physiotherapists who help stroke patients regain mobility or speech pathologists who do swallowing assessments to determine whether or not it’s safe to eat. Further research is necessary to examine these possibilities.
In the meantime, says Kapral, health-care administrators should try to determine what is causing the increased mortality gap. “I think hospitals should really look at their weekend practices in terms of staffing and resources to see if there are things that can be done to improve care on weekends.
The researchers looked at data from 20,657 patients seen in the emergency room or admitted to one of Ontario’s 11 regional stroke centres between July 1, 2003 and March 30, 2008.
People seen on weekends had an 8.1-per-cent risk of dying within seven days compared to a seven-per-cent risk for those admitted during the week. After adjustments for age, the severity of the stroke and the patients’ other medical problems, the researchers determined that patients were 12 per cent more likely to die if they were admitted on the weekend.
Dr. Mark Bayley, the medical director of the Neuro Rehabilitation Program at Toronto Rehab, believes the mortality gap is likely caused by less access to physiotherapists, occupational therapists, speech pathologists and nurses with stroke expertise on the weekends.
Stroke is a 24-7 problem and it needs expertise 24 hours a day, seven days a week,” he says.
On the more positive side, says Bayley, who did not work on the study, the research suggests the comprehensive interprofessional approach used by stroke units does help save lives, especially from Monday to Friday.
The province’s 11 stroke centres are in major city hospitals. Bayley points out that hospitals in smaller cities with fewer staff are likely to have an even greater problem on weekends.
The study also found patients with minor stroke symptoms were less likely to admit themselves to the hospital on the weekend than those with more serious strokes.
Despite the relationship between weekend admittance and mortality rates, Kapral says, people should get themselves to a hospital immediately after having stroke symptoms, no matter what day of the week.
We want people to recognize that even a minor stroke is considered a medical emergency and there are treatments that can help — but they need to be given early,” she says.