Commenting on the recent study, The Effect of Out of Hours Presentation with Acute Stroke on Processes of Care and Outcomes: Analysis of data from the Stroke Improvement National Audit Programme (SINAP), published in the PLOS ONE journal, Professor Tony Rudd said:
This study, which covers over 45,000 stroke patients in England, set out to find out if inequalities exist in the quality of care and mortality rates in stroke care. We did this through looking at differences in the quality of care received by patients admitted with a stroke during normal hours and out-of-hours. The study shows that there are significant differences both in the patient population admitted with stroke out of hours, and in the quality of the care that they receive. Despite presenting with more severe strokes, patients admitted out-of-hours are less likely to receive timely access to key investigations and interventions, such as brain scanning and stroke unit admission.
These data show that in this large sample of contemporary stroke care in England, there remain significant inequalities in care standards depending on the time of day and day of week that a patient has a stroke. Our data show that there is excess mortality associated with out of hours admission, but suggest that this can largely be explained by differences in severity of the stroke and the prognosis. However, when looking in particular at the cohort of patients arriving at weekends, we found that they have a higher risk of mortality within 30 days of being admitted. Acute stroke services therefore need to be available on a 24/7 basis in order to provide the best quality of care for patients admitted out-of-hours.
For further information, please contact Hannah Bristow, Clinical Standards communications officer, on 020 3075 1447 / 07584 303 784 or email Hannah.Bristow@rcplondon.ac.uk
- The article can be accessed here: http://dx.plos.org/10.1371/journal.pone.0087946
- Professor Tony Rudd is chair of the Intercollegiate Stroke Working Party (ICSWP) hosted by the Royal College of Physicians (RCP).
- The Stroke Improvement National Audit Programme (SINAP) is a national clinical audit, which collected information from hospitals about stroke patient care in the first 3 days in hospital. SINAP was run by the RCP stroke programme on behalf of the Intercollegiate Stroke Working Party and commissioned by the Healthcare Quality Improvement Partnership (HQIP). Data submission for SINAP has now ended. The new stroke audit, the Sentinel Stroke National Audit Programme (SSNAP), is now the single source of stroke data nationally.
- PLOS ONE publishes primary research from all areas of science and employs a combination of peer review and post-publication rating and commenting to maximize the impact of every report it publishes. It is published by the Public Library of Science (PLOS), the open-access publisher whose goal is to make the world’s scientific and medical literature a public resource. All works published in PLOS ONE are Open Access.