Abstract WP325: A Travel Time and Efficiency Simulation for Patient Transport to Primary and Comprehensive Stroke Centers

Abstract

Introduction: The purpose of this study was to identify the conditions in which bypassing a near Primary Stroke Centers (PSC) to go straight to a further Comprehensive Stroke Centers (CSC) leads to shorter time to treatment (IV Alteplase and mechanical thrombectomy). Methods: For this study, two simulations were performed. The first simulation evaluated time to IV Alteplase, taking in account travel and door-to-needle (DTN) times. The second simulation evaluated time to thrombectomy and accounted for travel time, door-in-door-out time if patient goes to PSC first, presence of absence of CTA at PSC, and door-to-groin (DTG) time at the CSC. In both simulations, we assumed that thrombectomy can only happen at the CSC. Regarding travel time, we implemented a rule that the longest distance between the three points of interest must be within three times the sum of the two smaller distances to be considered feasible. For example, if the patient was 5 minutes from the PSC and 5 minutes from the CSC, it would not be logical to consider a case where it takes over 30 minutes to travel from the PSC to the CSC. Results: For the first simulation, in 46.6% of cases DTN was faster going to the PSC. This occurred when the combination of travel time and PSC efficiency outweighed those elements at the CSC. In 6.8% of cases, the hospitals provided treatment within an equal amount of time. For the second simulation, DTG was better going straight to CSC in the vast majority (86.7%) of cases, assuming CTA must be done at the CSC. If CTA can be done at either hospital, going to PSC first was favored in a small number of cases (10.5%). In 2.8% of cases, the hospitals provided treatment within an equal amount of time. Conclusion: This study illustrates that an efficient PSC with CTA capability would lead to faster DTN and DTG times. A universal prehospital triaging model would not benefit all patients in all scenarios if it is only based on time to reach destination hospital. Such a model should take in account the quality of care and the available resources in the community.