Optimising acute stroke care organisation: a simulation study to assess the potential to increase intravenous thrombolysis rates and patient gains.

ABSTRACT: OBJECTIVES:To assess potential increases in intravenous thrombolysis (IVT) rates given particular interventions in the stroke care pathway. DESIGN:Simulation modelling was used to compare the performance of the current pathway, best practices based on literature review and an optimised model. SETTING:Four hospitals located in the North of the Netherlands, as part of a centralised organisational model. PARTICIPANTS:Ischaemic stroke patients prospectively ascertained from February to August 2010. INTERVENTION:The interventions investigated included efforts aimed at patient response and mode of referral, prehospital triage and intrahospital delays. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome measure was thrombolysis utilisation. Secondary measures were onset-treatment time (OTT) and the proportion of patients with excellent functional outcome (modified Rankin scale (mRS) 0-1) at 90 days. RESULTS:Of 280 patients with ischaemic stroke, 125 (44.6%) arrived at the hospital within 4.5?hours, and 61 (21.8%) received IVT. The largest improvements in IVT treatment rates, OTT and the proportion of patients with mRS scores of 0-1 can be expected when patient response is limited to 15?min (IVT rate +5.8%; OTT -6?min; excellent mRS scores +0.2%), door-to-needle time to 20?min (IVT rate +4.8%; OTT -28?min; excellent mRS scores+3.2%) and 911 calls are increased to 60% (IVT rate +2.9%; OTT -2?min; excellent mRS scores+0.2%). The combined implementation of all potential best practices could increase IVT rates by 19.7% and reduce OTT by 56?min. CONCLUSIONS:Improving IVT rates to well above 30% appears possible if all known best practices are implemented.

SUBMITTER: Lahr MMH 

PROVIDER: S-EPMC7045180 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature