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Inclusion of Hospital Performance in Prehospital Stroke Routing: A Simulation Study.

Kori S Zachrison^1,2, Lee H Schwamm³, Yizhou Cui¹

¹Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.

Prehospital Emergency Care

|June 16, 2026

Summary

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This summary is machine-generated.

Prehospital stroke routing can be improved by using actual hospital performance data. This enhanced model directs patients to hospitals with faster reperfusion times, improving stroke care.

Area of Science:

Emergency Medicine
Neurology
Health Services Research

Background:

Prehospital routing for stroke patients is complex.
Current guidelines may not reflect real-world hospital performance.
Door-to-needle and door-to-puncture times are critical for stroke treatment.

Purpose of the Study:

To compare prehospital stroke routing strategies.
To evaluate the impact of actual hospital performance data on routing decisions.
To determine if enhanced models improve destination selection compared to consensus recommendations.

Main Methods:

A decision-analytic model was used, incorporating geographic, patient, and hospital data.
The model was enhanced with real-world door-to-needle/puncture times from Northeast US hospitals.

Keywords:

emergency medical services hospital performance prehospital care simulation modeling stroke

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400,000 patient-location scenarios were simulated to compare three routing strategies.

Main Results:

Routing destinations differed from consensus recommendations in 56.1% (base model) and 63.1% (enhanced model) of scenarios.
Patients were more frequently directed to hospitals with faster reperfusion times using the enhanced model.
Higher stroke severity and likelihood of large vessel occlusion correlated with alignment to recommendations.

Conclusions:

Prehospital stroke routing models can be significantly improved by incorporating actual hospital performance data.
The enhanced model, using real-time data, offers a more optimized approach to stroke patient destination selection.
This data-driven approach may lead to more timely and effective stroke interventions.