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, MD, assistant professor of neurology at Robert Wood Johnson Medical School, and medical director of the Comprehensive Stroke Center at Robert Wood Johnson University Hospital, who 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 Robert Wood Johnson Medical School had 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 Dr. 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 from UMDNJ-Robert Wood Johnson Medical School: Yingzi Deng, MD, adjunct instructor of medicine, and John B. Kostis, MD, professor and chair of medicine and founding director of the Cardiovascular Institute of New Jersey; and Scott Kasner, MD, from the department of neurology at the University of Pennsylvania School of Medicine in Philadelphia.
Moving forward, the researchers hope to examine more current data with the recently developed New Jersey Acute Stroke Registry. The study was funded by The Robert Wood Johnson Foundation and the Schering-Plough Foundation.
Patient story may be found at: https://www.rwjuh.edu/news/rwjuh-breakthroughs-bolstad-guardian-angel.html
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 and follow us on Twitter www.twitter.com/UMDNJ_RWJMS.
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 Robert Wood Johnson University Hospital
Robert Wood Johnson University Hospital (RWJUH) is a 600-bed academic medical center and the principal hospital of UMDNJ-Robert Wood Johnson Medical School in New Brunswick, NJ. Robert Wood Johnson is an innovative leader in advancing state-of-the-art care. RWJUH is the first hospital in the nation to implant the AbioCor self-contained artificial heart since the device received FDA approval in 2006. RWJUH is one of only three sites in the nation approved to offer this groundbreaking technology. Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, and women’s and children’s care including The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital (www.bmsch.org). The hospital is also a Level 1 Trauma Center and serves as a national resource in its ground-breaking approaches to emergency preparedness. The hospital has earned significant national recognition for clinical quality and patient safety. RWJUH ranks among the best hospitals in America, according to U.S.News & World Report’s 2011 ranking of “America’s Best Hospitals.” It is the fifth consecutive year that RWJUH has achieved this prestigious ranking. The American College of Surgeons’ Commission on Cancer has rated RWJUH among the nation’s best comprehensive cancer centers. The Leapfrog Group rated RWJUH as one of the 50 exceptional U.S. hospitals, as published in Consumers Digest magazine. Harvard University researchers, in a study commissioned by The Commonwealth Fund, identified RWJUH as one of the top 10 hospitals in the nation for clinical quality. RWJUH is also a four-time recipient of the prestigious Magnet Award for Nursing Excellence. Visit us online at www.rwjuh.edu.
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