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Prehospital Thrombolysis: A Manual from Berlin
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Discrete-Event Simulation to Model the Thrombolysis Process for Acute Ischemic Stroke Patients at Urban and Rural
Tessa Bulmer1, David Volders2,3, John Blake1
1Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
Frontiers in Neurology
|November 15, 2021
Summary
Discrete-event simulation (DES) models hospital processes to improve tissue plasminogen activator (tPA) treatment times. Combining process changes and reducing activity durations significantly cut door-to-needle time (DNT) in urban and rural settings.
Area of Science:
- Healthcare Operations Research
- Medical Process Improvement
- Simulation Modeling in Medicine
Background:
- Effective treatment with tissue plasminogen activator (tPA) requires rapid administration.
- Door-to-needle time (DNT) is a critical metric for hospital efficiency and patient outcomes.
- Discrete-event simulation (DES) offers a method to model and evaluate process improvements for DNT reduction.
Purpose of the Study:
- To develop a conceptual framework and DES model for the thrombolysis process.
- To simulate and test various process improvement scenarios to identify optimal strategies for reducing DNT.
- To determine the largest potential improvement in DNT at different hospital sites (urban and rural).
Main Methods:
- A conceptual framework of the thrombolysis process was created.
- A discrete-event simulation (DES) model was developed using ARENA software.
- Activity duration data from three hospital sites were used to simulate five scenarios, including process changes and duration reductions, individually and in combination.
Main Results:
- Administering tPA in the imaging area yielded the largest DNT reduction for two urban/suburban sites (12.6% and 8.2%).
- Keeping emergency medical services (EMS) patients on their stretchers to imaging provided the greatest DNT improvement for a rural site (9.2%).
- Combining all simulated scenarios achieved the maximum DNT reduction of 26.7% (median) and 17.1% (90th percentile).
Conclusions:
- The conceptual framework effectively illustrates intra-hospital thrombolysis logistics.
- Rural hospitals may benefit most from EMS stretcher continuity to imaging, while urban sites gain from tPA administration in imaging.
- Optimizing critical path activities and combining process changes with duration reductions can significantly improve DNT in both urban and rural settings.
