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Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis

Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis
Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis
Objectives:
The policy of centralising hyperacute stroke units (HASUs) in England aims to provide stroke care in units that are both large enough to sustain expertise (>600 admissions/year) and dispersed enough to rapidly deliver time-critical treatments (<30 min maximum travel time). Currently, just over half (56%) of patients with stroke access care in such a unit. We sought to model national configurations of HASUs that would optimise both institutional size and geographical access to stroke care, to maximise the population benefit from the centralisation of stroke care.

Design Modelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.

Setting 127 acute stroke services in England, serving a population of 54 million people.

Participants 238 887 emergency admissions with acute stroke over a 3-year period (2013–2015).

Intervention Modelled reconfigurations of HASUs optimised for institutional size and geographical access.

Main outcome measure Travel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.

Results Solutions were identified with 75–85 HASUs with annual stroke admissions in the range of 600–2000, which achieve up to 82% of patients attending a stroke unit within 30 min estimated travel time (with at least 95% and 98% of the patients being within 45 and 60 min travel time, respectively).

ConclusionsThe reconfiguration of hyperacute stroke services in England could lead to all patients being treated in a HASU with between 600 and 2000 admissions per year. However, the proportion of patients within 30 min of a HASU would fall from over 90% to 80%–82%.
2044-6055
Allen, Michael
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Pearn, Kerry
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Villeneuve, Emma
95920483-a601-41db-ae55-e33fe9b06754
Monks, Thomas
fece343c-106d-461d-a1dd-71c1772627ca
Stein, Ken
dba3ca57-81c5-4172-a80e-2b38f61a7cc1
James, Martin
cdc24687-d17d-4bec-aed7-f827777f6b7a
Allen, Michael
a177adf5-62e3-4e62-b154-d9bf4d0cae5a
Pearn, Kerry
378600fc-7eaf-4667-a1f0-8bc6df773810
Villeneuve, Emma
95920483-a601-41db-ae55-e33fe9b06754
Monks, Thomas
fece343c-106d-461d-a1dd-71c1772627ca
Stein, Ken
dba3ca57-81c5-4172-a80e-2b38f61a7cc1
James, Martin
cdc24687-d17d-4bec-aed7-f827777f6b7a

Allen, Michael, Pearn, Kerry, Villeneuve, Emma, Monks, Thomas, Stein, Ken and James, Martin (2017) Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis. BMJ Open, 7. (doi:10.1136/bmjopen-2017-018143).

Record type: Article

Abstract

Objectives:
The policy of centralising hyperacute stroke units (HASUs) in England aims to provide stroke care in units that are both large enough to sustain expertise (>600 admissions/year) and dispersed enough to rapidly deliver time-critical treatments (<30 min maximum travel time). Currently, just over half (56%) of patients with stroke access care in such a unit. We sought to model national configurations of HASUs that would optimise both institutional size and geographical access to stroke care, to maximise the population benefit from the centralisation of stroke care.

Design Modelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.

Setting 127 acute stroke services in England, serving a population of 54 million people.

Participants 238 887 emergency admissions with acute stroke over a 3-year period (2013–2015).

Intervention Modelled reconfigurations of HASUs optimised for institutional size and geographical access.

Main outcome measure Travel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.

Results Solutions were identified with 75–85 HASUs with annual stroke admissions in the range of 600–2000, which achieve up to 82% of patients attending a stroke unit within 30 min estimated travel time (with at least 95% and 98% of the patients being within 45 and 60 min travel time, respectively).

ConclusionsThe reconfiguration of hyperacute stroke services in England could lead to all patients being treated in a HASU with between 600 and 2000 admissions per year. However, the proportion of patients within 30 min of a HASU would fall from over 90% to 80%–82%.

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More information

Accepted/In Press date: 12 October 2017
e-pub ahead of print date: 14 December 2017
Published date: December 2017

Identifiers

Local EPrints ID: 416486
URI: https://eprints.soton.ac.uk/id/eprint/416486
ISSN: 2044-6055
PURE UUID: 81acc876-3a05-45d6-a96a-03c73d87163d
ORCID for Thomas Monks: ORCID iD orcid.org/0000-0003-2631-4481

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Date deposited: 20 Dec 2017 17:30
Last modified: 19 Jul 2019 00:44

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