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The scope for improvement in hyper-acute stroke care in Scotland: Operations Research for Health Care

The scope for improvement in hyper-acute stroke care in Scotland: Operations Research for Health Care
The scope for improvement in hyper-acute stroke care in Scotland: Operations Research for Health Care
Thrombolysis is associated with reduced disability for selected patients who have suffered ischemic stroke. However only a fraction of all patients who have suffered this type of stroke receive thrombolysis. The short time window of 4.5 h in which treatment is licensed means that rapid care and well-organized pathways are essential. We studied measures to increase the uptake of thrombolysis through a better understanding of the hospital delays which lead to a lack of timely brain scanning and diagnosis. We examine the factors influencing the number of thrombolysed patients, the time between arrival at hospital and the administration of thrombolysis (door to needle time). Our analysis is based on the Scottish Stroke Care Audit (SSCA) data covering all stroke patients admitted to hospitals in Scotland in 2010, as well as on interviews with stroke care staff in Scotland. The data show significant variation in the speed of scanning, thrombolysis treatment and number of patients receiving treatment among hospitals. In the best performing hospital, 68% of patients arriving within 4 h of stroke onset are scanned in time for thrombolysis compared with 40% on average and 5% in the worst performing hospital. We model the system as a discrete-event simulation following the patient journey, starting when patients have a stroke and ending at thrombolysis for those who qualify. The simulation results show that just improving the performance of all hospitals to the level of the best performing hospital would (even without improvements in onset to arrival times) increase the thrombolysis rate from 6% (in 2010) to 11% of all admitted stroke patients in Scotland. By 2013 9% of patients were receiving thrombolysis, suggesting there is still room for improvement. © 2015.
Discrete-event simulation Hospital delay Stroke care Telestroke Thrombolysis
50-60
Uzun Jacobson, Evin
06f2b51b-cbd0-4675-9676-4c43ae84953f
Bayer, Steffen
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
MacLeod, Mary Joan
60ec9660-c4d5-47b2-9afb-692c5a7d2d4c
Barlow, James
51253e7e-517c-48b6-98b0-ac82b00a600f
Dennis, Martin
06608a2d-5a02-4719-8067-08098bd38791
Uzun Jacobson, Evin
06f2b51b-cbd0-4675-9676-4c43ae84953f
Bayer, Steffen
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
MacLeod, Mary Joan
60ec9660-c4d5-47b2-9afb-692c5a7d2d4c
Barlow, James
51253e7e-517c-48b6-98b0-ac82b00a600f
Dennis, Martin
06608a2d-5a02-4719-8067-08098bd38791

Uzun Jacobson, Evin, Bayer, Steffen, MacLeod, Mary Joan, Barlow, James and Dennis, Martin (2015) The scope for improvement in hyper-acute stroke care in Scotland: Operations Research for Health Care. Operations Research for Health Care, 6, 50-60. (doi:10.1016/j.orhc.2015.09.003).

Record type: Article

Abstract

Thrombolysis is associated with reduced disability for selected patients who have suffered ischemic stroke. However only a fraction of all patients who have suffered this type of stroke receive thrombolysis. The short time window of 4.5 h in which treatment is licensed means that rapid care and well-organized pathways are essential. We studied measures to increase the uptake of thrombolysis through a better understanding of the hospital delays which lead to a lack of timely brain scanning and diagnosis. We examine the factors influencing the number of thrombolysed patients, the time between arrival at hospital and the administration of thrombolysis (door to needle time). Our analysis is based on the Scottish Stroke Care Audit (SSCA) data covering all stroke patients admitted to hospitals in Scotland in 2010, as well as on interviews with stroke care staff in Scotland. The data show significant variation in the speed of scanning, thrombolysis treatment and number of patients receiving treatment among hospitals. In the best performing hospital, 68% of patients arriving within 4 h of stroke onset are scanned in time for thrombolysis compared with 40% on average and 5% in the worst performing hospital. We model the system as a discrete-event simulation following the patient journey, starting when patients have a stroke and ending at thrombolysis for those who qualify. The simulation results show that just improving the performance of all hospitals to the level of the best performing hospital would (even without improvements in onset to arrival times) increase the thrombolysis rate from 6% (in 2010) to 11% of all admitted stroke patients in Scotland. By 2013 9% of patients were receiving thrombolysis, suggesting there is still room for improvement. © 2015.

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More information

Accepted/In Press date: 6 September 2015
e-pub ahead of print date: 11 September 2015
Published date: 11 September 2015
Keywords: Discrete-event simulation Hospital delay Stroke care Telestroke Thrombolysis
Organisations: Decision Analytics & Risk

Identifiers

Local EPrints ID: 410963
URI: http://eprints.soton.ac.uk/id/eprint/410963
PURE UUID: 00d38d67-70a5-4380-92f2-fa1c6572aa1b
ORCID for Steffen Bayer: ORCID iD orcid.org/0000-0002-7872-467X

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Date deposited: 12 Jun 2017 16:31
Last modified: 09 Jan 2022 02:27

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Contributors

Author: Evin Uzun Jacobson
Author: Steffen Bayer ORCID iD
Author: Mary Joan MacLeod
Author: James Barlow
Author: Martin Dennis

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