AUTHOR=Lillicrap Thomas , Pinheiro Alex , Miteff Ferdinand , Garcia-Bermejo Pablo , Gangadharan Shyam , Wellings Thomas , O'Brien Billy , Evans James , Alanati Khaled , Bivard Andrew , Parsons Mark , Levi Christopher , Garcia-Esperon Carlos , Spratt Neil 

TITLE=No Evidence of the “Weekend Effect” in the Northern New South Wales Telestroke Network

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00130

DOI=10.3389/fneur.2020.00130

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Admission outside normal business hours has been associated with prolonged door-to-treatment times and poorer patient outcomes, the so called “weekend effect. ” This is the <italic>first</italic> examination of the weekend effect in a telestroke service that uses multi-modal computed tomography.</p><p><bold>Aims:</bold> To examine differences in workflow and triage between in-hours and out-of-hours calls to a telestroke service.</p><p><bold>Methods:</bold> All patients assessed using the Northern New South Wales (N-NSW) telestroke service from April 2013 to January 2019 were eligible for inclusion (674 in total; 539 with complete data). The primary outcomes measured were differences between in-hours and out-of-hours in door-to-call-to-decision-to-needle times, differences in the proportion of patients confirmed to have strokes or of patients selected for reperfusion therapies or patients with a modified Rankin Score (mRS ≤ 2) at 90 days.</p><p><bold>Results:</bold> There were no significant differences between in-hours and out-of-hours in any of the measured times, nor in the proportions of patients confirmed to have strokes (67.6 and 69.6%, respectively, <italic>p</italic> = 0.93); selected for reperfusion therapies (22.7 and 22.6%, respectively, <italic>p</italic> = 0.56); or independent at 3 months (34.8 and 33.6%, respectively, <italic>p</italic> = 0.770). There were significant differences in times between individual hospitals, and patient presentation more than 4.5 h after symptom onset was associated with slower times (21 minute delay in door-to-call, <italic>p</italic> = 0.002 and 22 min delay in door-to-image, <italic>p</italic> = 0.001).</p><p><bold>Conclusions:</bold> The weekend effect is not evident in the Northern NSW telestroke network experience, though this study did identify some opportunities for improvement in the delivery of acute stroke therapies.</p>