Institute of Epidemiology & Health Care


METRO24/7: Mixed methods analysis of the London Hyperacute Stroke System:

Seven-day working in hospitals is a priority of health research and policy, in the UK and internationally. Research suggests that patients receive poorer care if admitted or treated outside conventional working hours. Several possible causes for an ‘out of hours effect’ are proposed but there are likely to be many relevant factors associated with out of hours working.

This study aims to analyse organisation and provision of 24/7 stroke care in all eight Hyperacute Stroke Units (HASUs) in London. It is using qualitative and quantitative methods to evaluate how time of admission to hospital and contextual factors influence quality of care provided and clinical outcomes at different times of the day and week.

In doing so, this research will identify lessons about the development, provision, effects and cost of 24/7 stroke care in the London HASU system, in order to support high quality 24/7 care in acute stroke and other healthcare settings.

Principal Investigator: Dr Robert Simister

Project Staff:

Professor Martin Brown, UCL

Mr Adrian Capp, UCLH NHS Foundation Trust

Professor Naomi Fulop: UCL

Dr Hans Rolf Jager, UCL

Dr Dianne Playford, UCL

Dr Angus Ramsay, UCL

Professor Anthony Rudd, King's College London


Dr Georgia Black, UCL

Dr Mariya Melnychuk, UCL

Funder: NIHR Health Services and Delivery Research Programme

Start Date: 2014

Duration:  6 years

Contact: angus.ramsay@ucl.ac.uk