An Optimization Model for the Tradeoff Between Efficiency and Equity for Mobile Stroke Unit Placement

2021 ◽  
pp. 183-193
Author(s):  
Saeid Amouzad Mahdiraji ◽  
Johan Holmgren ◽  
Radu-Casian Mihailescu ◽  
Jesper Petersson
Keyword(s):  
Optimization Model ◽  
Stroke Unit ◽  
Mobile Stroke Unit

Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 116-123
Author(s):  
Mathew Cherian ◽  
Pankaj Mehta ◽  
Shriram Varadharajan ◽  
Santosh Poyyamozhi ◽  
Elango Swamiappan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Retrospective Review ◽  
Stroke Unit ◽  
Care Pathway ◽  
Clinical Care ◽  
Stroke Care ◽  
First Year ◽  
Proof Of Concept ◽  
Mobile Stroke Unit ◽  
Clinical Care Pathway

Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.

scholarly journals The mobile stroke unit and management of acute stroke in rural settings

2018 ◽  
Vol 190 (28) ◽  
pp. E855-E858 ◽  
Author(s):  
Ashfaq Shuaib ◽  
Thomas Jeerakathil
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Mobile Stroke Unit ◽  
Rural Settings

Abstract WP72: Early Experience on Intravenous Tissue Plasminogen Activator Delivery in Mobile Stroke Unit Patients with Stroke Mimics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lila E Sheikhi ◽  
Stacey Winners ◽  
Pravin George ◽  
Andrew Russman ◽  
Zeshaun Khawaja ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Early Experience ◽  
Final Diagnosis ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background: A mobile stroke unit (MSU) allows for early delivery for intravenous tissue plasminogen activator (IV-tPA). A proportion of IV-tPA treated patients may turn out to be stroke mimics. We evaluated the rate and complications seen in stroke mimics treated with tPA from our early experience on MSU. Methods: Retrospective review of patients treated with IV-tPA on the MSU from 2014 to 2016. Charts were reviewed for confirmed strokes by imaging (MRI or CT) and hemorrhagic transformation. Stroke mimics were defined as those without imaging evidence of infarction and a final diagnosis which was not suspected to be stroke. Results: Among 62 patients treated with IV-tPA, 14 (28.6%) had a final diagnosis consistent with a stroke mimics. The majority of these occurred in the first year of the MSU program. Most common mimics included conversion disorder (n=5) and seizures (n=5). While the last known well to IV-tPA times were similar, the MSU door-to-needle time was significantly longer in stroke mimics (38 vs 31 minutes, p = 0.03). No intracerebral hemorrhages or other IV-tPA related complications were identified in the stroke mimics group. Conclusions: In our early experience with MSU, treatment of stroke mimics occurred without IV-tPA related complications. This does not appear to be due to rushed decision making.

Abstract WP339: Validation of the Fast-ed Scale Use by Paramedics in a Mobile Stroke Unit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Diogo C Haussen ◽  
Raul G Nogueira ◽  
Nirav Bhatt ◽  
Carol Flemming ◽  
Nicolas Bianchi ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Hospital Setting ◽  
Final Diagnosis ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Hospital Arrival ◽  
Mobile Stroke Unit ◽  
Standard Operating ◽  
Intravenous Alteplase ◽  
Cerebrovascular Imaging

Introduction: FAST-ED scale is a helpful tool to triage stroke patients in the field. However, data on the accuracy of the scale in the pre-hospital setting is lacking. We aim to validate the use of FAST-ED by paramedics in a mobile stroke unit (MSU) covering a metropolis. Methods: As part of standard operating MSU procedures, paramedics clinically evaluated patients. If the event characterized a stroke alert, the FAST-ED score was determined by the paramedic (in-person) upon patient contact, and independently by a vascular neurologist (telemedicine) immediately after the paramedic evaluation. An MSU nurse determined the NIHSS. This will allow testing of the inter-rater agreement of the FAST-ED scoring performance between on-site pre-hospital providers and remotely located vascular neurologists. Results: In the first 13 months of the MSU’s activity 193 stroke-alert patients were evaluated. 103 (53%) patients had a final diagnosis of stroke/TIA (75/28, respectively), 21 (11%) intracranial hemorrhage, and 69 (36%) were considered stroke mimics. 28 (14%) patients received intravenous alteplase. In the first 48 patients, FAST-ED was only scored by the paramedic and in 145 patients by both the physician and paramedic. FAST-ED scores matched perfectly amongst paramedics and physicians in 77 (53%) instances, while there was only 1-point difference in 51 (35%), 2-point difference in 10 (6%) and 3-point difference in two. Correlation between physician and paramedic FAST-ED scores was highly positive (rho 0.898; 2-sided p<0.001), as well as the correlation between physicians FAST-ED score and NIHSS (rho 0.853; 2-sided p<0.001). When the physician recorded FAST-ED score≥3 (n=62), the paramedics also scored FAST-ED≥3 in the vast majority of instances (n=55; 89%). After hospital arrival, cerebrovascular imaging was deemed necessary and performed in 144 patients within 24 hours of arrival. A visible large vessel occlusion was identified in 30 patients; 18 occlusions were identified with a FAST-ED≥3 while 12 were missed (10/12 had NIHSS≤5). Conclusion: The correlation of the FAST-ED scoring between vascular neurologists and paramedics was highly positive, indicating that FAST-ED is accurately and reliably utilized by paramedics in the pre-hospital setting.

Abstract 13: The Feasibility and Development of a Mobile Stroke Unit in a Community Setting

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Hillary S Crumlett ◽  
Anne Lindstrom ◽  
Mehr Mohajer-Esfahani ◽  
Harish Shownkeen
Keyword(s):  
Stroke Unit ◽  
Community Setting ◽  
Mobile Stroke Unit

Abstract TP223: Then and Now: Temporal Evolution of a Mobile Stroke Unit

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Lila E Sheikhi ◽  
Naresh Mullaguri ◽  
A. Blake Buletko ◽  
Jason Mathew ◽  
Tapan Thacker ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Temporal Evolution ◽  
Mobile Stroke Unit

Abstract TP291: Melbourne Mobile Stroke Unit Increases Stroke Treatment Rates and Treatment Opportunities

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Skye Coote ◽  
Henry Zhao ◽  
Lauren Pesavento ◽  
Francesca Langenberg ◽  
Patricia Desmond ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Treatment ◽  
Mobile Stroke Unit

Abstract WP215: Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
James P Rhudy ◽  
Anne W Alexandrov ◽  
Joseph Rike ◽  
Tomas Bryndziar ◽  
Ana Hossein Zadeh Maleki ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Service Performance ◽  
Mobile Stroke Unit

Abstract WP323: Significant Reduction in Prehospital Evaluation and Door-to-Treatment Times With a Mobile Stroke Unit

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Robert G Kowalski ◽  
Brandi Schimpf ◽  
Derek Wilson ◽  
Sharon N Poisson ◽  
Eric M Nyerg ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Mobile Stroke Unit

scholarly journals Mobile Stroke Unit in the UK Healthcare System: Avoidance of Unnecessary Accident and Emergency Admissions

2020 ◽  
Vol 49 (4) ◽  
pp. 388-395
Author(s):  
Iris Q. Grunwald ◽  
Daniel J. Phillips ◽  
David Sexby ◽  
Viola Wagner ◽  
Martin Lesmeister ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Hospital Treatment ◽  
Stroke Patients ◽  
Transient Ischaemic Attacks ◽  
Accident And Emergency ◽  
Mobile Stroke Unit ◽  
The Uk

Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&amp;E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&amp;E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&amp;E departments.

Sign in / Sign up

Export Citation Format

Share Document