ArticleBMJ open2017
Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke.Journal of neurointerventional surgery · 2024Observational
- Geographical Requirements for the Applicability of the Results of the RACECAT Study to Other Stroke Networks.Journal of the American Heart Association · 2023Article
- How can consultant-led childbirth care at time of delivery be maximised? A modelling study.BMJ open · 2020Article
- Article
- Maximising access to thrombectomy services for stroke in England: A modelling study.European stroke journal · 2019Article
- Planning and Providing Acute Stroke Care in England: The Effect of Planning Footprint Size.Frontiers in neurology · 2019Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe 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.
designModelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.
setting127 acute stroke services in England, serving a population of 54 million people.
participants238 887 emergency admissions with acute stroke over a 3-year period (2013-2015).
interventionModelled reconfigurations of HASUs optimised for institutional size and geographical access.
main outcome measureTravel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.
resultsSolutions 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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