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dc.contributor.authorSimister, R
dc.contributor.authorBlack, GB
dc.contributor.authorMelnychuk, M
dc.contributor.authorRamsay, AIG
dc.contributor.authorBaim-Lance, A
dc.contributor.authorCohen, DL
dc.contributor.authorEng, J
dc.contributor.authorXanthopoulou, PD
dc.contributor.authorBrown, MM
dc.contributor.authorRudd, AG
dc.contributor.authorMorris, S
dc.contributor.authorFulop, NJ
dc.date.accessioned2020-10-01T09:49:07Z
dc.date.issued2020-09-02
dc.description.abstractBackground Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of the day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units. Objectives To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units, and to identify factors influencing such variations. Design This was a prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme. Factors influencing variations in care and outcomes were studied through interview and observation data. Setting The setting was acute stroke services in London hyperacute stroke units. Participants A total of 7094 patients with a primary diagnosis of stroke took part. We interviewed hyperacute stroke unit staff (n = 76), including doctors, nurses, therapists and administrators, and 31 patients and carers. We also conducted non-participant observations of delivery of care at different times of the day and week (n = 45, ≈102 hours). Intervention Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards was designed to deliver uniform access to high-quality hyperacute stroke unit care across the week. Main outcome measures Indicators of quality of acute stroke care, mortality at 3 days after admission, disability at the end of the inpatient spell and length of stay. Data sources Sentinel Stroke National Audit Programme data for all patients in London hyperacute stroke units with a primary diagnosis of stroke between 1 January and 31 December 2014, and nurse staffing data for all eight London hyperacute stroke units for the same period. Results We found no variation in quality of care by day and time of admission across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor in 3-day mortality nor disability at hospital discharge. Other quality-of-care measures significantly varied by day and time of admission. Quality of care was better if the nurse in charge was at a higher band and/or there were more nurses on duty. Staff deliver ‘front-door’ interventions consistently by taking on additional responsibilities out of hours, creating continuities between day and night, building trusting relationships and prioritising ‘front-door’ interventions. Limitations We were unable to measure long-term outcomes as our request to the Sentinel Stroke National Audit Programme, the Healthcare Quality Improvement Partnership and NHS Digital for Sentinel Stroke National Audit Programme data linked with patient mortality status was not fulfilled. Conclusions Organisational factors influence 24 hours a day, 7 days a week (24/7), provision of stroke care, creating temporal patterns of provision reflected in patient outcomes, including mortality, length of stay and functional independence. Future work Further research would help to explore 24/7 stroke systems in other contexts. We need a clearer understanding of variations by looking at absolute time intervals, rather than achievement of targets. Research is needed with longer-term mortality and modified Rankin Scale data, and a more meaningful range of outcomes.en_GB
dc.description.sponsorshipNational Institute for Health Research (NIHR)en_GB
dc.identifier.citationVol. 8 (34)en_GB
dc.identifier.doi10.3310/hsdr08340
dc.identifier.urihttp://hdl.handle.net/10871/123046
dc.language.isoenen_GB
dc.publisherNIHR Journals Libraryen_GB
dc.rights© Queen’s Printer and Controller of HMSO 2020. This work was produced by Simister et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.en_GB
dc.titleTemporal variations in quality of acute stroke care and outcomes in London hyperacute stroke units: a mixed-methods studyen_GB
dc.typeArticleen_GB
dc.date.available2020-10-01T09:49:07Z
dc.identifier.issn2050-4349
dc.descriptionThis is the final version. Available from the NIHR Journals Library via the DOI in this recorden_GB
dc.identifier.journalHealth Services and Delivery Researchen_GB
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserveden_GB
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2020-09-02
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2020-10-01T09:47:48Z
refterms.versionFCDVoR
refterms.dateFOA2020-10-01T09:49:11Z
refterms.panelAen_GB


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