ArticleBMJ open2020
Optimising acute stroke care organisation: a simulation study to assess the potential to increase intravenous thrombolysis rates and patient gains.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Implementation of a Transitional Care Model for Stroke: Perspectives From Frontline Clinicians, Administrators, and COMPASS-TC Implementation Staff.The Gerontologist · 2020Trial
- Global Awareness and Response to Early Symptoms of Acute Stroke: A Systematic Literature Review.Cureus · 2025Review
- The Cost and the Value of Stroke Care in Greece: Results from the SUN4P Study.Healthcare (Basel, Switzerland) · 2023Article
- Article
- Optimising acute stroke pathways through flexible use of bed capacity: a computer modelling study.BMC health services research · 2022Article
- Study on the Mechanism of Üstikuddus Sherbiti in Ischemic Cerebrovascular Diseases: Based on Network Pharmacology.Evidence-based complementary and alternative medicine : eCAM · 2022Article
- Discrete-Event Simulation to Model the Thrombolysis Process for Acute Ischemic Stroke Patients at Urban and Rural Hospitals.Frontiers in neurology · 2021Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess potential increases in intravenous thrombolysis (IVT) rates given particular interventions in the stroke care pathway.
designSimulation modelling was used to compare the performance of the current pathway, best practices based on literature review and an optimised model.
settingFour hospitals located in the North of the Netherlands, as part of a centralised organisational model.
participantsIschaemic stroke patients prospectively ascertained from February to August 2010.
interventionThe interventions investigated included efforts aimed at patient response and mode of referral, prehospital triage and intrahospital delays. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was thrombolysis utilisation. Secondary measures were onset-treatment time (OTT) and the proportion of patients with excellent functional outcome (modified Rankin scale (mRS) 0-1) at 90 days.
resultsOf 280 patients with ischaemic stroke, 125 (44.6%) arrived at the hospital within 4.5 hours, and 61 (21.8%) received IVT. The largest improvements in IVT treatment rates, OTT and the proportion of patients with mRS scores of 0-1 can be expected when patient response is limited to 15 min (IVT rate +5.8%; OTT -6 min; excellent mRS scores +0.2%), door-to-needle time to 20 min (IVT rate +4.8%; OTT -28 min; excellent mRS scores+3.2%) and 911 calls are increased to 60% (IVT rate +2.9%; OTT -2 min; excellent mRS scores+0.2%). The combined implementation of all potential best practices could increase IVT rates by 19.7% and reduce OTT by 56 min.
conclusionsImproving IVT rates to well above 30% appears possible if all known best practices are implemented.
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