Table 2

Quality of care and outcomes across four periods in the week

London HASUsRest of England
WeekdayWeekendWeekdayWeekendP values*WeekdayWeekendWeekdayWeekendP values*
08:00-19:5908:00-19:5920:00-07:5920:00-07:5908:00-19:5908:00-19:5920:00-07:5920:00-07:59
Quality of care measures
 Brain scan within 1 hour0.60 (0.58–0.61)0.61 (0.58–0.63)0.63 (0.60–0.65)0.65 (0.61–0.68)0.03440.44 (0.44–0.45)0.41 (0.40–0.41)0.40 (0.39–0.40)0.39 (0.38–0.41)<0.0001
 Brain scan within 12 hours0.97 (0.96–0.97)0.96 (0.95–0.97)0.95 (0.94–0.96)0.95 (0.93–0.96)0.00930.90 (0.90–0.90)0.88 (0.87–0.89)0.84 (0.83–0.84)0.83 (0.82–0.84)<0.0001
 Dysphagia screen within 4 hours0.74 (0.72–0.75)0.75 (0.73–0.77)0.77 (0.75–0.79)0.79 (0.76–0.82)0.00290.70 (0.70–0.71)0.65 (0.64–0.66)0.60 (0.59–0.61)0.58 (0.56–0.59)<0.0001
 Assessment by a nurse trained in stroke management within 24 hours0.96 (0.95–0.96)0.94 (0.93–0.96)0.95 (0.94–0.96)0.95 (0.94–0.97)0.18720.89 (0.88–0.89)0.85 (0.85–0.86)0.86 (0.86–0.87)0.83 (0.82–0.84)<0.0001
 Administration of intravenous thrombolysis to eligible patients0.88 (0.86–0.90)0.88 (0.84–0.92)0.86 (0.82–0.91)0.88 (0.82–0.95)0.93270.81 (0.80–0.82)0.80 (0.78–0.82)0.76 (0.74–0.78)0.76 (0.72–0.79)<0.0001
 Door-to-needle time within 1 hour in patients receiving thrombolysis0.84 (0.81–0.87)0.89 (0.85–0.93)0.79 (0.74–0.84)0.84 (0.77–0.91)0.02690.60 (0.59–0.62)0.48 (0.45–0.50)0.38 (0.35–0.40)0.37 (0.33–0.41)<0.0001
 Assessment by a stroke specialist consultant physician within 12 hours0.39 (0.38-.40)0.30 (0.27–0.32)0.63 (0.61–0.66)0.64 (0.60–0.68)<0.00010.48 (0.48–0.49)0.30 (0.29–0.31)0.51 (0.51–0.52)0.42 (0.41–0.44)<0.0001
 Assessment by a stroke specialist consultant physician within 24 hours0.90 (0.89–0.91)0.87 (0.85–0.89)0.90 (0.88–0.91)0.92 (0.90–0.94)0.00430.80 (0.79–0.80)0.65 (0.65–0.66)0.75 (0.74–0.75)0.62 (0.61–0.64)<0.0001
 Admission to a stroke unit within 4 hours0.62 (0.60–0.63)0.64 (0.61–0.66)0.67 (0.65–0.70)0.70 (0.67–0.74)<0.00010.63 (0.63–0.63)0.59 (0.58–0.60)0.55 (0.54–0.56)0.53 (0.52–0.55)<0.0001
 Physiotherapist assessment within 72 hours0.83 (0.82–0.84)0.86 (0.84–0.88)0.85 (0.83–0.87)0.84 (0.81–0.87)0.06930.82 (0.81–0.82)0.83 (0.82–0.84)0.81 (0.81–0.82)0.82 (0.80–0.83)0.0010
 Occupational therapist assessment within 72 hours0.79 (0.78–0.80)0.82 (0.80–0.84)0.81 (0.79–0.82)0.80 (0.76–0.83)0.09670.73 (0.73–0.74)0.75 (0.75–0.76)0.73 (0.72–0.74)0.73 (0.72–0.74)<0.0001
 Swallow assessment by a SLT within 72 hours0.92 (0.91–0.93)0.93 (0.91–0.95)0.93 (0.91–0.95)0.91 (0.88–0.95)0.58380.80 (0.80–0.81)0.81 (0.80–0.82)0.79 (0.78–0.80)0.80 (0.78–0.82)0.0946
 Communication assessment by a SLT within 72 hours0.53 (0.51–0.54)0.56 (0.54–0.59)0.55 (0.53–0.58)0.52 (0.48–0.56)0.07390.33 (0.32–0.33)0.36 (0.35–0.37)0.34 (0.33–0.35)0.34 (0.32–0.35)<0.0001
 Physiotherapist assessment within 24 hours0.56 (0.54–0.57)0.47 (0.45–0.50)0.65 (0.63–0.68)0.48 (0.44–0.52)<0.00010.54 (0.54–0.55)0.41 (0.40–0.41)0.53 (0.52–0.54)0.35 (0.34–0.37)<0.0001
 Occupational therapist assessment within 24 hours0.49 (0.47–0.50)0.42 (0.40–0.45)0.58 (0.55–0.60)0.41 (0.37–0.45)<0.00010.43 (0.42–0.43)0.31 (0.30–0.31)0.42 (0.42–0.43)0.26 (0.25–0.27)<0.0001
 Communication assessment by a SLT within 24 hours0.29 (0.28–0.31)0.22 (0.20–0.24)0.39 (0.37–0.42)0.23 (0.20–0.27)<0.00010.17 (0.17–0.17)0.10 (0.09–0.10)0.19 (0.18–0.20)0.08 (0.07–0.09)<0.0001
Outcome measures
 Mortality at 3 days0.03 (0.02–0.03)0.03 (0.02–0.04)0.03 (0.02–0.04)0.02 (0.01–0.03)0.33100.04 (0.04–0.05)0.04 (0.04–0.04)0.05 (0.04–0.05)0.05 (0.04–0.05)0.1055
 mRS score 3–60.55 (0.53–0.56)0.55 (0.52–0.57)0.55 (0.52–0.57)0.56 (0.53–0.59)0.86720.48 (0.48–0.48)0.49 (0.48–0.50)0.51 (0.50–0.51)0.51 (0.50–0.52)<0.0001
 mRS score 3–5†0.49 (0.47–0.50)0.47 (0.45–0.50)0.48 (0.45–0.50)0.48 (0.44–0.51)0.74970.40 (0.39–0.40)0.40 (0.39–0.41)0.40 (0.39–0.41)0.40 (0.39–0.41)0.3746
Length of stay
 Length of stay in HASU (days)3.1 (3.0–3.2)3.4 (3.2–3.5)3.0 (2.9–3.1)3.1 (2.9–3.3.)0.0007
 Length of stay in hospital (days)10.8 (10.2–11.3)12.1 (11.1–13.1)10.8 (10.0–11.7)11.5 (10.2–12.9)0.03598.5 (8.4–8.6)9.2 (9.0–9.4)9.7 (9.4–9.9)10.1 (9.6–10.5)<0.0001
  • Figures are average predicted probabilities (95% CIs) of each measure in each time period controlling for the covariates.

  • *P value threshold adjusted for multiple testing is 0.0025 for London HASUs and 0.0024 for the rest of England.

  • †Patients who died were not included.

  • HASU, hyperacute stroke units; mRS, modified Rankin Scale; SLT, speech and language therapist.