Stroke centers no worse at weekend treatment

• Stroke • Sep 14, 11

Hospitals that have been designated as “stroke centers” may provide just as good care on the weekend as on weekdays, new findings suggest.

That’s important because previous studies have hinted that people who come to the hospital after having a stroke don’t do as well if they’re admitted over the weekend, when nurses and specialists might be stretched extra thin.

“This is a big concern among the physician community because we all know that not every hospital has the capacity to treat those patients on the weekend,” said Dr. Ying Xian, who studies stroke care at the Duke Clinical Research Institute in Durham, North Carolina and wasn’t involved in the new study.

“What is most amazing in this study is that they show that comprehensive stroke centers have the capacity to (eliminate) those disparities in terms of weekend status,” he told Reuters Health.

In 11 years of stroke data from New Jersey hospitals, 37,000 patients who were admitted on a weekend or holiday were slightly less likely to survive the next few months than 97,000 who arrived on a weekday.

After 90 days, 17.2 percent of weekend patients had died, compared to 16.5 percent of weekday patients. Weekend admission meant people who had suffered a stroke were about five percent less likely to survive that long, when other factors were also considered.

But when researchers focused on the 12 out of 88 hospitals that had been deemed comprehensive stroke centers, weekend arrival did not mean a higher risk of death, according to findings published in Stroke.

Hospitals that qualified as primary stroke centers—meaning they provided care in between non-centers and comprehensive centers—still didn’t do as well on the weekend.

One caveat is that New Jersey didn’t begin certifying stroke centers until 2007. (An organization called The Joint Commission started accrediting hospitals nationwide in 2003.) So for the most part, the data comes from before “stroke center” designations were made.

Still, the researchers said, those hospitals were probably providing the best stroke care before that was made official.

In general, “there’s a decrease in the quantity and spectrum of care that’s provided on the weekend,” said Dr. James McKinney, the study’s lead author from the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick.

But at stroke centers, “it’s kind of a 24-hour, seven-day-a-week operation,” he told Reuters Health. “There’s really not a fall off regardless of the time of day or day of the week.”

Stroke centers, Xian explained, always need to have a stroke specialist on call, and brain imaging services available.

“We are seeing increasing evidence that the designation of primary stroke centers (and) comprehensive stroke centers is having an impact on care,” said Mat Reeves, an epidemiologist from Michigan State University in East Lansing who wasn’t involved in the research.

That supports a recent push in the healthcare field to recognize “centers of excellence” that specialize in treating certain conditions.

In some states, ambulances are required to take patients with stroke symptoms to the nearest stroke center.

But because that’s not always the case, “be an advocate for yourself or your family member to go to a specialty center for stroke if there’s one close by,” Reeves told Reuters Health. “It’s not worth driving four hours for… (but) when that’s an option, I would want my family members and myself to go to those centers.”

Researchers emphasized that the most important thing to do when someone is having a stroke is still to call 911.

SOURCE: Stroke, September 2011.