Study Indicates that Comprehensive Stroke Centers May Overcome “Weekend Effect”
Article Published by the American Heart Association
August 25, 2011
NEW BRUNSWICK, N.J. – A team of researchers has found that New Jersey patients who are admitted on weekends and holidays to a hospital that is designated a Comprehensive Stroke Center do not have a higher mortality rate than patients admitted during the week.
Physicians at The Cardiovascular Institute of New Jersey (CVI) at UMDNJ-Robert Wood Johnson Medical School and the Comprehensive Stroke Center at Robert Wood Johnson University Hospital conducted the study, which was published in Stroke: Journal of the American Heart Association. This study suggests better outcomes, on average, in hospitals with a Comprehensive Stroke Center designation, in contrast with earlier studies of myocardial infarctions (heart attacks) that found the “weekend effect” to be significant at all non-federal, acute care hospitals in New Jersey.
“We are very encouraged by the data we uncovered,” said James S. McKinney, M.D., assistant professor of neurology at Robert Wood Johnson Medical School and medical director of the Comprehensive Stroke Center at Robert Wood Johnson University Hospital. McKinney led the study. “We determined that comprehensive stroke centers in New Jersey overcome the ‘weekend effect,’ and that they do so through appropriate hospital staffing and organization of acute stroke care thereby saving patients’ lives.”
In previous myocardial infarction studies, CVI researchers at UMDNJ-Robert Wood Johnson Medical School found higher mortality rates among patients admitted on Saturdays, Sundays and holidays, outcomes they associated with reduced hospital staffing and minimal use of invasive cardiac procedures during the weekend, known as the “weekend effect.”
The researchers utilized the Myocardial Infarction Data Acquisition System, or MIDAS, a statewide database coordinated by the CVI, that tracks hospitalizations for myocardial infarction (heart attacks), stroke, other vascular diseases, and deaths from 1990 to the present. The team compared patients admitted with a primary diagnosis of cerebral infarction (stroke) between 1996 and 2007 as listed in MIDAS, with in- and out-of-hospital deaths as listed in New Jersey death registration files. They determined that more than 134,400 patients were admitted with a primary diagnosis of stroke during the study period. Those admitted on the weekends to New Jersey hospitals (27.8 percent) had a significantly higher risk of death by 90 days than those admitted during the week.
However, for 23.4 percent of the patients admitted on the weekend to a hospital designated a Comprehensive Stroke Center, the researchers found that there was no difference in mortality from those admitted during the week.
They also determined that stroke patients were significantly more likely to be admitted to comprehensive stroke centers on weekends since New Jersey enacted the Stroke Center Act in 2004. Twelve hospitals throughout New Jersey are designated Comprehensive Stroke Centers, 10 of which were so designated when certification began in 2007.
“We also examined differences in stroke care from the beginning of 1996 through 2007 and noted marked improvement,” said McKinney. Specifically, the study reports “…our results speak to the existence of superior care at CSC [comprehensive stroke centers].” In addition to organized action plans for stroke care, the study noted that stroke patients admitted on the weekends were more likely to receive stroke treatment that involves giving a thrombolytic “clot-busting” drug through an intravenous (IV) line – 10 times more likely in 2006-07 than in 1998-99.
The research team included Yingzi Deng, M.D., adjunct instructor of medicine, and John B. Kostis, M.D., professor and chair of medicine and founding director of the Cardiovascular Institute of New Jersey, from UMDNJ-Robert Wood Johnson Medical School and Scott Kasner, M.D., from the department of neurology at the University of Pennsylvania School of Medicine in Philadelphia.
The study was funded by The Robert Wood Johnson Foundation and the Schering-Plough Foundation.
Moving forward, the researchers hope to examine more current data with the recently developed New Jersey Acute Stroke Registry.
About the Comprehensive Stroke Center at Robert Wood Johnson University Hospital
The state-designated Comprehensive Stroke Center at Robert Wood Johnson University Hospital offers compassionate, state-of-the-art care for people who have had a stroke or other critical neurologic conditions. The Stroke Center at Robert Wood Johnson University Hospital has been awarded the Gold Seal of Approval and achieved Disease-Specific Care Certification for Acute Care Stroke from The Joint Commission.
The Center’s interdisciplinary Stroke Center Steering Committee regularly reviews stroke care response and practices with an eye toward enhancing the hospital’s overall performance in stroke care. The committee has initiated improvements such as a “brain attack” overhead page to ensure that the hospital’s stroke care team is assembled as quickly as possible once hospital staff is alerted that a stroke patient is on the way. The team also works closely with emergency medical service crews on educational programs to help them quickly identify early stroke symptoms.
About UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL
As one of the nation’s leading comprehensive medical schools, UMDNJ-Robert Wood Johnson Medical School is dedicated to the pursuit of excellence in education, research, health care delivery, and the promotion of community health. In cooperation with Robert Wood Johnson University Hospital, the medical school’s principal affiliate, they comprise New Jersey’s premier academic medical center. In addition, Robert Wood Johnson Medical School has 34 other hospital affiliates and ambulatory care sites throughout the region.
As one of the eight schools of the University of Medicine and Dentistry of New Jersey with 2,800 full-time and volunteer faculty, Robert Wood Johnson Medical School encompasses 22 basic science and clinical departments, hosts centers and institutes including The Cancer Institute of New Jersey, the Child Health Institute of New Jersey, the Center for Advanced Biotechnology and Medicine, the Environmental and Occupational Health Sciences Institute, and the Stem Cell Institute of New Jersey. The medical school maintains educational programs at the undergraduate, graduate and postgraduate levels for more than 1,500 students on its campuses in New Brunswick, Piscataway, and Camden, and provides continuing education courses for health care professionals and community education programs. To learn more about UMDNJ-Robert Wood Johnson Medical School, log on to rwjms.umdnj.edu. Find our fan page at www.Facebook.com/RWJMS
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About Robert Wood Johnson University Hospital
Robert Wood Johnson University Hospital (RWJUH) is a 965-bed academic medical center with campuses in New Brunswick and Somerville, NJ. Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, stroke care, neuroscience, joint replacement, and women’s and children’s care including The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital (www.bmsch.org).
As the flagship Cancer Hospital of Rutgers Cancer Institute of New Jersey and the principal teaching hospital of Rutgers Robert Wood Johnson Medical School in New Brunswick, RWJUH is an innovative leader in advancing state-of-the-art care. A Level 1 Trauma Center and the first Pediatric Trauma Center in the state, RWJUH’s New Brunswick campus serves as a national resource in its ground-breaking approaches to emergency preparedness.
RWJUH has been ranked among the best hospitals in America by U.S. News & World Report seven times and has been selected by the publication as a high performing hospital in numerous specialties. The Bristol-Myers Squibb Children’s Hospital has been ranked among the best hospitals in America by U.S. News & World Report three times. In addition, RWJUH was named among the best places to work in health care by Modern Healthcare magazine and received the Equity Care of Award as Top Hospital for Healthcare Diversity and Inclusion from the American Hospital Association.
Both the New Brunswick and Somerset campuses have earned significant national recognition for clinical quality and patient safety, including the prestigious Magnet® Award for Nursing Excellence and “Most Wired” designation by Hospitals and Health Networks Magazine. The Joint Commission and the New Jersey Department of Health and Senior Services have designated the New Brunswick Campus as a Comprehensive Stroke Center and the Somerset Campus as a Primary Stroke Center.
The American College of Surgeons’ Commission on Cancer has rated RWJUH New Brunswick among the nation’s best comprehensive cancer centers and designated the Steeplechase Cancer Center at RWJ Somerset as a Comprehensive Community Cancer Center. The Joint Surgery Center at Robert Wood Johnson University Hospital Somerset has earned the Joint Commission’s Gold Seal of Approval for total knee and total hip replacement surgery.