Regional access to acute ischemic stroke intervention.

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Recombinant tissue plasminogen activator (rtPA) therapy for acute ischemic stroke is time-sensitive, with reduced efficacy beyond 3 hours.
• Equitable access to rtPA is crucial for improving patient outcomes in large geographical areas.

Purpose of the Study:

• To enhance therapeutic effectiveness of rtPA by ensuring equitable access for acute ischemic stroke patients.
• To establish a coordinated regional system response for stroke care within a large referral base.

Main Methods:

• Development of a Regional Acute Stroke Protocol (RASP) involving all emergency medical services providers.
• Implementation of a system where ambulances bypass local hospitals to transport eligible patients directly to a tertiary facility.

Main Results:

• After 12 months, 403 ischemic strokes occurred, with 191 RASP activations.
• 42 patients received rtPA, representing 5% of all acute strokes and 10% of ischemic strokes in the region.
• Ambulance services began bypassing closest hospitals to deliver patients to Kingston General Hospital.

Conclusions:

• Acute stroke patients in Southeastern Ontario demonstrated improved access to stroke interventions.
• Geographical barriers were overcome, proving that regional systems can ensure access to time-critical stroke care.
• rtPA treatment was administered to a significant percentage of eligible acute ischemic stroke patients within the region.