The scope for improvement in hyper-acute stroke care in Scotland

Publication date: Available online 11 September 2015 Source:Operations Research for Health Care Author(s): Evin Uzun Jacobson, Steffen Bayer, James Barlow, Martin Dennis, Mary Joan MacLeod 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-organised 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 numbers 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 journ...
Source: Operations Research for Health Care - Category: Hospital Management Source Type: research