Optimal patient protocols in regional acute stroke care

Area of Science:

• Healthcare Operations Research
• Emergency Medical Services
• Stroke Neurology

Background:

• Rapid reperfusion treatment is critical for acute stroke patient outcomes.
• Current emergency medical services (EMS) patient allocation and treatment location strategies are often suboptimal.
• Minimizing delays in acute stroke care is paramount, as "time equals brain".

Purpose of the Study:

• To develop a mathematical model for optimizing stroke treatment facility locations and patient allocation.
• To minimize the total time from ambulance call to reperfusion treatment initiation.
• To evaluate the performance of existing patient allocation protocols against an optimal model.

Main Methods:

• Formulated acute stroke care as a multi-flow, two-level hierarchical facility location problem.
• Developed a mixed integer linear programming model to minimize total treatment time.
• Incorporated volume-dependent in-hospital delays into the model.
• Analyzed the performance of "mothership" and "drip-and-ship" protocols.

Main Results:

• The "mothership protocol" (direct transport to specialized stroke centers) was 3.9% slower than the optimal model.
• "Drip-and-ship" (transport to nearest regional center) was 8.6% slower than optimal.
• Optimal model reduced treatment time by up to 18.9 minutes per patient.
• Drip-and-ship showed advantages in rural areas with low demand for interventional procedures.

Conclusions:

• Optimized facility location and patient allocation can significantly reduce acute stroke treatment times.
• The mothership protocol offers a near-optimal solution for stroke patient management.
• Mathematical modeling provides valuable insights for improving EMS protocols and stroke care efficiency.