Dying from stroke in England

Patients who are admitted to hospital at the weekend suffering from a
stroke are less likely to receive vital brain scans and more are more
likely to die than those seen during the week, a study of NHS
hospitals has found.

A team from Imperial College London and the National Audit Office has
found 350 people die within seven days of their stroke unnecessarily
because they were admitted at the weekend and a further 650 suffer
serious disability.

Among stroke patients admitted Sundays, 11 per cent died within seven
days, compared with less than nine per cent of those admitted on

Dr Tony Rudd, a stroke consultant at Guy’s and St Thomas’s in London,
and spokesman for the Royal College of Physicians, said: “It’s
unacceptable for the NHS to be operating as if people only get ill
between Monday and Friday, from nine ‘til five.”

The so-called ‘weekend effect’ was more pronounced in patients aged
under 44 who were 60 per cent more likely to die after being admitted
at the weekend compared with people aged over 85.
It was also found that weekend patients were more likely to suffer a
serious disability as the result of their stroke because they were
less likely to be discharged home within eight weeks.

It has been thought that deaths increase among patients admitted at
the weekend because there are fewer senior staff on duty to diagnose
patients quickly and order the right treatments.

The study found patients suffering a stroke at the weekend were less
likely to be seen by a neurologist or a geriatric medicine specialist
and more likely to be treated by a specialist in general medicine, A&E
and other specialities.

The findings based on more than 93,000 admissions, were published in
the journal Archives of Neurology.

Every year 150,000 people suffer a stroke and patients can suffer
serious brain damage if they are not treated quickly.

Strokes can be caused by a the bleed in the brain or a blockage caused
by a clot which requires drugs to dissolve.

Research by Dr Foster Intelligence, published last year, found that
patients admitted for emergency treatment at weekends were almost 10
per cent more likely to die than those admitted during the rest of the

However, it is thought this is the first time that deaths attributed
to a single condition have been found to be higher at weekends in the

Bruce Keogh, Medical Director of the NHS, has said he wants hospitals
to work as normal at weekends and for senior staff to be on duty
carrying out routine work as well as emergency cases.

He has said hospital should look no different on a Sunday to how they
do on a Wednesday.

Lead author William Palmer, a researcher at Imperial College and the
National Audit Office, and colleagues conducted a study of patients
admitted to hospitals with stroke from April 2009 to March 2010.

In five of the six measures, performance was lower at weekends, it was found.

Mr Palmer wrote in the journal: “Strong evidence suggests that,
nationally, stroke patients admitted on weekends are less likely to
receive urgent treatments and have worse outcomes across a range of

“The evidence of lower performance across process and outcome measures
on weekends suggests that care for patients admitted on weekends was

He added: “The results have significant implications; in the NHS in
England, stroke is the largest cause of adult disability and costs £3
billion a year for direct care.

“Several possible explanations for these findings include fewer
clinical staff working in hospitals on weekends, with those who do
work often having less experience and lower familiarity with the
patients; less accessibility of resources, such as radiologists to
operate the scanners.”

It was found that 48 per cent of patients were scanned on the day of
admission on weekdays compared with 43 per cent at weekends, 2.7 per
cent were given clot-busting drugs on weekdays compared with 2.2 per
cent at weekends and five per cent contracted pneumonia if they were
admitted during the week compared with almost six per cent admitted at

The researchers said one possible solution is to reorganise stroke
services into fewer larger hospitals which are more able to offer high
quality care seven days a week.

Services in London were altered in this way in February 2010 and early
results show that it has been successful, although mortality data is
not yet available.

Suspected stroke patients in the capital are now taken by ambulance
past their nearest hospital to a dedicated stroke unit which operates
scanners seven days a week and has specialists on duty round the

Dr Rudd added: “We’ve known for a long time that the quality of care
at weekends is not as good in some parts of the country as it is
during the week.

“We know that’s also true for a lot of other conditions, such as heart
attacks and surgical emergencies.”

The NHS needed to ensure more consultants were available out of office
hours in all areas of urgent specialist care, he argued.

The way stroke services were delivered had already been changed in
London and Manchester, to deliver care at fewer, bigger centres that
were better equipped to deal with patients, he said.

These changes – made since the data in the report were collected – had
resulted in significant improvements for patients, he added.

Similar alterations were being brought in throughout the Midlands and
East of England next year, he said.

He said: “Patients don’t mind being taken a bit further in an
ambulance, if they get the right quality care.”

Joe Korner from Stroke Association said: “When a stroke strikes, time
lost is brain lost and urgent medical attention is absolutely

“A brain scan is vital to determine the type of stroke and what
treatment the patient should receive.

“Access to scans has improved over the last few years, but they are
not always available seven days a week and this needs to change.

“Stroke has a massive and sudden impact, affecting people physically
and emotionally. We believe that every stroke survivor should receive
the right treatment at the right time so that they can make their best
possible recovery.”

Simon Burns, the Health Minister, said:” We have already set out that
we want patients to get the same level of service on a Saturday or
Sunday as they do on a Wednesday.

“Not only would this mean better, safer and more consistent care and
treatment, it will also mean better support for junior doctors.

“That is why we are taking action and working with professional
associations to drive this forward across the NHS.

“We have also seen the benefits that focussing care in specialist
stroke units can have.

“Early evidence from the redesigned stroke services in London suggests
that the mortality rate in London is now around 18 per cent lower than
the national average.”