Abstract
Background: Guidelines in England recommend that hyperacute stroke units (HASUs) should have a minimum of 600 confirmed stroke admissions per year in order to sustain expert consultant-led services, and that travel time for patients should ideally be 30 min or less. Currently, 61% of stroke patients attend a unit with at least 600 admissions per year and 56% attend such a unit and have a travel time of no more than 30 min.Objective: We have sought to understand how varying the planning and provision footprint in England affects access to care whilst achieving the recommended admission numbers for hyper-acute stroke care. We have compared two different planning footprints to national-level planning: planning using five NHS Regions in England, and planning using 44 Sustainability and Transformation Partnerships (STPs) in England.Methods: Computer modeling and optimization using a multi-objective genetic algorithm.Results: The number of stroke admissions between STPs varies by seven-fold, while the number of stroke admissions between NHS Regions varies by 2.5-fold. In order to meet stroke admission guidelines (600/year) for all units the maximum possible proportion of patients within 30 min would be 82, 78, and 72% with no boundaries to planning/provision, NHS Region boundaries, and STP boundaries (in these scenarios patients cannot move outside of their own STP or NHS Region). If STP or NHS Region boundaries are removed for provision of service (after planning is performed at these local levels), travel time is improved, but number of admissions to individual hospitals become significantly changed, especially at STP planning level where admission numbers per unit changed by an average of 204 (19%), and not all units maintained 600 admissions after removal of boundaries.Conclusion: Planning and providing services at STP level could lead to sub-optimal service provision compared with using larger and more consistently populated planning areas.
Highlights
Stroke is a major cause of burden on individuals and healthcare services
If Sustainability and Transformation Partnerships (STPs) or NHS Region boundaries are removed for provision of service, travel time is improved, but number of admissions to individual hospitals become significantly changed, especially at STP planning level where admission numbers per unit changed by an average of 204 (19%), and not all units maintained 600 admissions after removal of boundaries
We have previously described the use of a genetic algorithm to optimize the planning of the number and locations of acute stroke services in order to maximize the proportion of patients with good access whilst meeting guidelines for the number of admissions (11, 12)
Summary
South West Peninsula, University of Exeter College Of Medicine and Health, University of Exeter, Exeter, United Kingdom, 2 Royal Devon and Exeter NHS Foundation Trust and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, Exeter, United Kingdom Reviewed by: Simone Beretta, Azienda Ospedaliera San Gerardo, Italy Noreen Kamal, Dalhousie University, Canada Benjamin B. Clissold, Monash University, Australia Specialty section: This article was submitted to Stroke, a section of the journal Frontiers in Neurology Received: 26 November 2018 Accepted: 05 February 2019 Published: 27 February 2019 Citation: Allen M, Pearn K, Villeneuve E, James M and Stein K (2019) Planning and Providing Acute Stroke Care in England: The Effect of Planning Footprint Size. Front. Neurol. 10:150. doi: 10.3389/fneur.2019.00150
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