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Published on: January 15, 2017
A simulation-based approach for improving utilization of thrombolysis in acute brain infarction
Maarten M H Lahr1, Durk-Jouke van der Zee, Gert-Jan Luijckx
1*Department of Neurology, University Medical Center Groningen †Department of Operations, Faculty of Economics & Business ‡Health Technology Assessment, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Simulation modeling can identify effective strategies to increase tissue plasminogen activator (tPA) treatment rates for acute brain infarction. Implementing a scoop-and-run protocol and point-of-care diagnostics significantly improves patient outcomes.
Area of Science:
- Neurology
- Health Services Research
- Medical Simulation
Background:
- Tissue plasminogen activator (tPA) is the gold standard for acute ischemic stroke treatment.
- Worldwide tPA treatment rates remain low (<10%) due to numerous implementation barriers.
- Traditional randomized controlled trials are resource-intensive and cannot efficiently test all potential solutions.
Purpose of the Study:
- To utilize simulation modeling to identify and evaluate interventions for overcoming barriers in acute stroke care pathways.
- To assess the impact of specific interventions on tPA treatment rates and process efficiency.
Main Methods:
- A simulation model of a regional Dutch acute stroke pathway was developed.
- Barriers within the pathway were identified through literature review and expert consultation.
- Potential solutions were configured and tested within the simulation environment.
Main Results:
- The simulation model accurately reflected observed tPA treatment rates (21.8% vs. 22.1%) and process times (129 min vs. 127 min).
- A 'scoop-and-run' protocol reduced on-scene time, increasing tPA rates by 1.4% and decreasing process time by 7 minutes.
- A point-of-care diagnostic device reduced time to laboratory results, increasing tPA rates by 3.2% and decreasing process time by 20 minutes.
Conclusions:
- Simulation modeling provides an efficient method for evaluating interventions to improve stroke care pathways.
- Implementing a scoop-and-run protocol and point-of-care diagnostics can substantially enhance tPA treatment rates and thrombolysis efficacy.
