Abstract 66: Is Hospital Discharge Day of the Week Associated with Measures of Care Continuity for Stroke Patients?

Abstract

Background: Facilitating care continuity from hospital to home has been shown for other disease states to reduce adverse health events. In this study we examined whether weekend discharges were less likely to have a follow-up appointment scheduled with either primary or specialty care for acute stroke patients discharged home. Methods: We examined data from 44 hospitals participating in the Ohio Coverdell Stroke program to determine the proportion of adult stroke patients discharged home who had a follow-up appointment scheduled with primary care or with specialty care (neurology, neurosurgery, or neurology provider) and whether this varied by patients’ hospital discharge day of the week (weekday vs. weekend). Facilitators and barriers to scheduling appointments prior to discharge were reported by stroke team members at a meeting of participating hospitals. Results: Among 44 hospitals, there were 4,635 patients discharged home from April-December 2013. Prior to discharge, hospital staff scheduled follow-up appointments for post-discharge care with a primary care provider for 15.2% of patients and with a specialty care provider for 27.2% of patients. A higher proportion of patients with a weekday discharge compared with weekend discharge had a follow-up appointment with primary care (16.4% vs. 8.5%, p<0.001) and specialty care (29.6% vs. 17.5%, p<0.001). Reported barriers to facilitating care continuity for weekend patient discharges included lack of availability of dedicated weekend hospital personnel to plan appointments with the patient and family, and limited or no access to online or electronic appointment scheduling or primary or specialty care office staff to schedule appointments. Conclusions: Although a significant number of patients were discharged home without a primary or specialty care appointment, patients discharged on the weekend were at a disadvantage for having a follow-up appointment scheduled prior to hospital discharge. Discharge planning earlier in the hospital stay and creative approaches to improving appointment scheduling with community-based providers could be explored as options for promoting improved care continuity for weekend discharges.