Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study.
<h4>Background</h4>Observational studies have reported higher mortality for patients admitted on weekends. It is not known whether this "weekend effect" is modified by clinical staffing levels on weekends. We aimed to test the hypotheses that rounds by stroke specialist physici...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2014-08-01
|
| Series: | PLoS Medicine |
| Online Access: | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1001705&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849469232130031616 |
|---|---|
| author | Benjamin D Bray Salma Ayis James Campbell Geoffrey C Cloud Martin James Alex Hoffman Pippa J Tyrrell Charles D A Wolfe Anthony G Rudd |
| author_facet | Benjamin D Bray Salma Ayis James Campbell Geoffrey C Cloud Martin James Alex Hoffman Pippa J Tyrrell Charles D A Wolfe Anthony G Rudd |
| author_sort | Benjamin D Bray |
| collection | DOAJ |
| description | <h4>Background</h4>Observational studies have reported higher mortality for patients admitted on weekends. It is not known whether this "weekend effect" is modified by clinical staffing levels on weekends. We aimed to test the hypotheses that rounds by stroke specialist physicians 7 d per week and the ratio of registered nurses to beds on weekends are associated with mortality after stroke.<h4>Methods and findings</h4>We conducted a prospective cohort study of 103 stroke units (SUs) in England. Data of 56,666 patients with stroke admitted between 1 June 2011 and 1 December 2012 were extracted from a national register of stroke care in England. SU characteristics and staffing levels were derived from cross-sectional survey. Cox proportional hazards models were used to estimate hazard ratios (HRs) of 30-d post-admission mortality, adjusting for case mix, organisational, staffing, and care quality variables. After adjusting for confounders, there was no significant difference in mortality risk for patients admitted to a stroke service with stroke specialist physician rounds fewer than 7 d per week (adjusted HR [aHR] 1.04, 95% CI 0.91-1.18) compared to patients admitted to a service with rounds 7 d per week. There was a dose-response relationship between weekend nurse/bed ratios and mortality risk, with the highest risk of death observed in stroke services with the lowest nurse/bed ratios. In multivariable analysis, patients admitted on a weekend to a SU with 1.5 nurses/ten beds had an estimated adjusted 30-d mortality risk of 15.2% (aHR 1.18, 95% CI 1.07-1.29) compared to 11.2% for patients admitted to a unit with 3.0 nurses/ten beds (aHR 0.85, 95% CI 0.77-0.93), equivalent to one excess death per 25 admissions. The main limitation is the risk of confounding from unmeasured characteristics of stroke services.<h4>Conclusions</h4>Mortality outcomes after stroke are associated with the intensity of weekend staffing by registered nurses but not 7-d/wk ward rounds by stroke specialist physicians. The findings have implications for quality improvement and resource allocation in stroke care. Please see later in the article for the Editors' Summary. |
| format | Article |
| id | doaj-art-5dad9739ca5e4bf9a31991d7df7fc01c |
| institution | Kabale University |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2014-08-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-5dad9739ca5e4bf9a31991d7df7fc01c2025-08-20T03:25:34ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762014-08-01118e100170510.1371/journal.pmed.1001705Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study.Benjamin D BraySalma AyisJames CampbellGeoffrey C CloudMartin JamesAlex HoffmanPippa J TyrrellCharles D A WolfeAnthony G Rudd<h4>Background</h4>Observational studies have reported higher mortality for patients admitted on weekends. It is not known whether this "weekend effect" is modified by clinical staffing levels on weekends. We aimed to test the hypotheses that rounds by stroke specialist physicians 7 d per week and the ratio of registered nurses to beds on weekends are associated with mortality after stroke.<h4>Methods and findings</h4>We conducted a prospective cohort study of 103 stroke units (SUs) in England. Data of 56,666 patients with stroke admitted between 1 June 2011 and 1 December 2012 were extracted from a national register of stroke care in England. SU characteristics and staffing levels were derived from cross-sectional survey. Cox proportional hazards models were used to estimate hazard ratios (HRs) of 30-d post-admission mortality, adjusting for case mix, organisational, staffing, and care quality variables. After adjusting for confounders, there was no significant difference in mortality risk for patients admitted to a stroke service with stroke specialist physician rounds fewer than 7 d per week (adjusted HR [aHR] 1.04, 95% CI 0.91-1.18) compared to patients admitted to a service with rounds 7 d per week. There was a dose-response relationship between weekend nurse/bed ratios and mortality risk, with the highest risk of death observed in stroke services with the lowest nurse/bed ratios. In multivariable analysis, patients admitted on a weekend to a SU with 1.5 nurses/ten beds had an estimated adjusted 30-d mortality risk of 15.2% (aHR 1.18, 95% CI 1.07-1.29) compared to 11.2% for patients admitted to a unit with 3.0 nurses/ten beds (aHR 0.85, 95% CI 0.77-0.93), equivalent to one excess death per 25 admissions. The main limitation is the risk of confounding from unmeasured characteristics of stroke services.<h4>Conclusions</h4>Mortality outcomes after stroke are associated with the intensity of weekend staffing by registered nurses but not 7-d/wk ward rounds by stroke specialist physicians. The findings have implications for quality improvement and resource allocation in stroke care. Please see later in the article for the Editors' Summary.https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1001705&type=printable |
| spellingShingle | Benjamin D Bray Salma Ayis James Campbell Geoffrey C Cloud Martin James Alex Hoffman Pippa J Tyrrell Charles D A Wolfe Anthony G Rudd Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. PLoS Medicine |
| title | Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. |
| title_full | Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. |
| title_fullStr | Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. |
| title_full_unstemmed | Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. |
| title_short | Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. |
| title_sort | associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses prospective multicentre cohort study |
| url | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1001705&type=printable |
| work_keys_str_mv | AT benjamindbray associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT salmaayis associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT jamescampbell associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT geoffreyccloud associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT martinjames associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT alexhoffman associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT pippajtyrrell associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT charlesdawolfe associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy AT anthonygrudd associationsbetweenstrokemortalityandweekendworkingbystrokespecialistphysiciansandregisterednursesprospectivemulticentrecohortstudy |