Mechanical thrombectomy in stroke - planning for service expansion using discrete event simulation

Area of Science:

• Neurology
• Interventional Neurology
• Health Services Research

Background:

• Mechanical thrombectomy (MT) is a time-sensitive reperfusion therapy for acute ischemic stroke due to large artery occlusion.
• Current MT services in the UK operate within specific hours, with plans for 24/7 expansion.
• District general hospitals (DGHs) play a vital role in the 'drip and ship' pathway and must prepare for service expansion.

Purpose of the Study:

• To discuss and model options for expanding mechanical thrombectomy services in a DGH and regional stroke network.
• To compare alternative workflow options for MT service expansion using real-world data and simulation.
• To provide a framework for NHS DGHs preparing for 24/7 MT availability.

Main Methods:

• Utilized data from the Sentinel Stroke National Audit Programme.
• Employed discrete event simulation to model and compare different workflow scenarios.
• Focused on a regional stroke network in south-west England.

Main Results:

• The study models and compares various workflow options for DGHs preparing for expanded MT services.
• Simulation results provide insights into optimizing patient flow and resource allocation.
• Identified potential strategies to support 24/7 MT availability.

Conclusions:

• Effective planning and workflow optimization are essential for successful MT service expansion.
• The modeled options can guide DGHs in preparing for increased demand and 24/7 services.
• Proactive preparation by DGHs is key to ensuring optimal patient outcomes in acute ischemic stroke management.