Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services
Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services
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DOI：
10.1136/bmjopen-2018-025366
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发表时间：
2019-11-01
期刊：
影响因子：
2.9
通讯作者：
Simister, Robert
中科院分区：
文献类型：
--
作者：
Melnychuk, Mariya;Morris, Stephen;Simister, Robert
目的探讨伦敦超急性卒中单元与英格兰其他地区相比，急性卒中护理质量和住院日及时间结局的差异。来自国家卒中哨兵审计计划的水平数据。设置伦敦超急性卒中单元和英格兰其他地区的急性卒中服务。参与者68239例初步诊断为卒中的患者2014年1月至12月期间入院。干预中心辐射模式，用于伦敦疑似急性卒中患者的护理，其性能标准旨在提供统一的高质量超急性卒中单元护理。主要结果测量急性卒中护理质量的16项指标，入院后3天的死亡率，住院期结束时的残疾，结果在伦敦超急性卒中单元中，就卒中护理评估、脑扫描和溶栓而言，在一周内入院的时间和一天的护理质量没有变化，出院时的3天死亡率或残疾率也没有变化（所有p值>0.05）。在伦敦，其他护理质量指标在一周内因入院日和时间而显著变化（所有p值
Objective To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units compared with the rest of England.Design Prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme.Setting Acute stroke services in London hyperacute stroke units and the rest of England.Participants 68 239 patients with a primary diagnosis of stroke admitted between January and December 2014.Interventions Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards designed to deliver uniform access to high-quality hyperacute stroke unit care across the week.Main outcome measures 16 indicators of quality of acute stroke care, mortality at 3 days after admission to the hospital, disability at the end of the inpatient spell, length of stay.Results There was no variation in quality of care by day and time of admission to the hospital across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor was there variation in 3-day mortality or disability at hospital discharge (all p values>0.05). Other quality of care measures significantly varied by day and time of admission across the week in London (all p values