Evidence map›Paper›PMID 31699710›Full record

ArticleBMJ open2019

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.

Mariya Melnychuk, Stephen Morris, Georgia Black, Angus I G Ramsay, Jeannie Eng, Anthony Rudd, Abigail Baim-Lance, Martin M Brown, Naomi J Fulop, Robert Simister

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
1.1field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
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  3. Article
  4. Review
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  6. Article
  7. Article
  8. Article
  9. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 3 countries.

Mariya MelnychukDepartment of Applied Health Research, University College London, London, UK.
Stephen MorrisDepartment of Applied Health Research, University College London, London, UK.
Georgia BlackDepartment of Applied Health Research, University College London, London, UK.ORCID 0000-0003-2676-5071
Angus I G RamsayDepartment of Applied Health Research, University College London, London, UK.ORCID 0000-0002-4446-6916
Jeannie EngCancer Division, University College London Hospitals NHS Foundation Trust, London.
Anthony RuddClinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
Abigail Baim-LanceInstitute for Implementation Science in Population Health, City University of New York, New York, USA.
Martin M BrownStroke Research Centre, UCL Queen Square Institute of Neurology, London.
Naomi J FulopDepartment of Applied Health Research, University College London, London, UK.ORCID 0000-0001-5306-6140
Robert SimisterStroke Research Centre, UCL Queen Square Institute of Neurology, London.
University College London · GBUniversity College London Hospitals NHS Foundation Trust · GBCity University of New York · USNIHR Queen Square Dementia Biomedical Research Unit · GBRoyal College of Physicians · GBUniversidad Rey Juan Carlos · ES

Funding

Department of Health 12/128/41
6 · The paper itself

Abstract

objectiveTo 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.

designProspective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme.

settingAcute stroke services in London hyperacute stroke units and the rest of England.

participants68 239 patients with a primary diagnosis of stroke admitted between January and December 2014.

interventionsHub-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 measures16 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.

resultsThere 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<0.01). In the rest of England there was variation in all measures by day and time of admission across the week (all p values<0.01), except for mortality at 3 days (p value>0.05).

conclusionsThe London hyperacute stroke unit model achieved performance standards for 'front door' stroke care across the week. The same benefits were not achieved by other models of care in the rest of England. There was no weekend effect for mortality in London or the rest of the England. Other aspects of care were not constant across the week in London hyperacute stroke units, indicating some performance standards were perceived to be more important than others.

Indexed as

Acute DiseaseAgedEnglandFemaleFollow-Up StudiesHospitalsHumansIncidenceIntensive Care UnitsMalePatient AdmissionPrognosisProspective StudiesQuality of Health CareStrokeSurvival Ratehealth economicsstroke

Identifiers

PMID31699710
PMCPMC6858222
OpenAlexW2986911540

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.