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Darehed, D., Blom, M., Glader, E.-L., Niklasson, J., Norrving, B., Bray, B. D. & Eriksson, M. (2019). Diurnal variations in the quality of stroke care in Sweden. Acta Neurologica Scandinavica, 140(2), 123-130
Open this publication in new window or tab >>Diurnal variations in the quality of stroke care in Sweden
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2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 140, no 2, p. 123-130Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: A recent study of acute stroke patients in England and Wales revealed several patterns of temporal variation in quality of care. We hypothesized that similar patterns would be present in Sweden and aimed to describe these patterns. Additionally, we aimed to investigate whether hospital type conferred resilience against temporal variation.

MATERIALS & METHODS: We conducted this nationwide registry-based study using data from the Swedish Stroke Register (Riksstroke) including all adult patients registered with acute stroke between 2011 and 2015. Outcomes included process measures and survival. We modeled time of presentation as on/off hours, shifts, day of week, 4h and 12 h time blocks. We studied hospital resilience by comparing outcomes across hospital types.

RESULTS: 113862 stroke events in 72 hospitals were included. The process indicators and survival all showed significant temporal variation. Door-to-needle (DTN) time within 30 minutes was less likely during nighttime than daytime (OR 0.50; 95% CI 0.41-0.60). Patients admitted during off-hours had lower odds of direct stroke unit (SU) admission (OR 0.72; 95% CI 0.70-0.75). 30-day survival was lower in nighttime versus daytime presentations (OR 0.90, 95% CI 0.84-0.96). The effects of temporal variation differed significantly between hospital types for DTN time within 30 minutes and direct SU admission where university hospitals were more resilient than specialized non-university hospitals.

CONCLUSIONS: Our study shows that variation in quality of care and survival is present throughout the whole week. We also found that university hospitals were more resilient to temporal variation than specialized non-university hospitals.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Off hours, Quality of care, Stroke, Temporal variation, Weekend effect, Weekly variation
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-158646 (URN)10.1111/ane.13112 (DOI)000474934000006 ()31046131 (PubMedID)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-09-06Bibliographically approved
Darehed, D., Blom, M., Glader, E.-L., Niklasson, J., Norrving, B. & Eriksson, M. (2018). Acute stroke patients are subject to seasonal variation in quality of care and survival: a Swedish nationwide registry-based study. International Journal of Stroke, 13, 177-177
Open this publication in new window or tab >>Acute stroke patients are subject to seasonal variation in quality of care and survival: a Swedish nationwide registry-based study
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2018 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 177-177Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Sage Publications, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-153663 (URN)000448113303022 ()
Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2018-11-26Bibliographically approved
Darehed, D., Norrving, B., Stegmayr, B., Zingmark, K. & Blom, M. C. (2017). Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: a Swedish multicenter register study. European Stroke Journal, 2(2), 178-186
Open this publication in new window or tab >>Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: a Swedish multicenter register study
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2017 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, Vol. 2, no 2, p. 178-186Article in journal (Refereed) Published
Abstract [en]

Introduction: It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome.

Patients and methods: This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011-2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission.

Results: A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978-0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6-5.5) for direct admission to a stroke unit versus the reference hospital.

Discussion and conclusion: We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Stroke, stroke unit, hospital bed occupancy, hospital admission, stroke care, emergency care, emergency department, bed crisis, The Swedish stroke register
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-153857 (URN)10.1177/2396987317698328 (DOI)000446624400010 ()
Funder
Norrbotten County Council
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-05-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5917-0384

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