Department of Neurology, Atkinson Morley Neuroscience Centre, St George's Hospital London.
J R Soc Med. 2010 Sep;103(9):363-9. doi: 10.1258/jrsm.2010.090434.
Audits in the United Kingdom and other countries show that only a small proportion of eligible stroke patients receive thrombolysis. Providing 24-hour thrombolysis cover presents major challenges in both infrastructure and staffing. One model for improving access is to provide out-of-hours cover in a regional centre but this may present problems including greater delays to hospital admissions.
Evaluation of the introduction of a 'hub-and-spoke' model of thrombolysis to increase access to thrombolysis for patients in south west London. One-year data are presented.
A network in south-west London comprised of a hub hospital and three district 'spoke' hospitals.
All suspected stroke admissions to a regional stroke centre. Main outcome measures Thrombolysis rates for acute stroke.
Increased out-of-hours thrombolysis rates were achieved with only a small increase in stroke admissions (approximately 10%) in the hub hospital. Thrombolysis rates increased from 1.2 per 100 stroke admissions for the local daytime service to 6 per 100 admissions for the regional service. Most patients thrombolysed were not local to the hub hospital. Only 1 in 4 patients considered for thrombolysis was thrombolysed, in line with previous data. Ten percent of all thrombolysis calls were not stroke but represented stroke mimics. Median length of stay was 6 days (target was 3 days). Fifty percent of the thrombolysed patients from spoke hospitals were discharged directly home.
In an urban area, a hub-and-spoke thrombolysis model increased access to thrombolysis without resulting in a marked increase in overall stroke admission numbers for the hub hospital. Proactive plans to repatriate patients back to district hospitals are required, and repatriation protocols have to prioritize regional patients over other targets in spoke hospitals to facilitate capacity in the hub hospital.
英国和其他国家的审核显示，只有一小部分符合条件的中风患者接受溶栓治疗。提供 24 小时溶栓服务在基础设施和人员配备方面都面临着重大挑战。改善服务可及性的一种模式是在区域中心提供非工作时间的覆盖，但这可能会带来一些问题，包括患者住院时间的延长。
评估引入“枢纽-辐射”溶栓模式以增加伦敦西南部患者接受溶栓治疗的机会。目前提供了一年的数据。
伦敦西南部的一个网络，包括一个枢纽医院和三个地区“辐射”医院。
所有疑似中风的患者均被送往区域中风中心。
急性中风溶栓率。
在枢纽医院中风入院人数仅略有增加（约 10%）的情况下，实现了更多非工作时间溶栓治疗。溶栓率从当地日间服务的每 100 例中风入院 1.2 例增加到区域服务的每 100 例入院 6 例。大多数接受溶栓治疗的患者并非来自枢纽医院所在地。符合溶栓条件的患者中，只有 1 例接受了溶栓治疗，与之前的数据相符。所有溶栓电话中，有 10%不是中风，但代表了中风模拟症。中位住院时间为 6 天（目标为 3 天）。来自辐射医院的 50%溶栓患者直接出院回家。
在城市地区，枢纽-辐射溶栓模式增加了溶栓治疗的可及性，而不会导致枢纽医院的总中风入院人数明显增加。需要制定积极的计划将患者遣返到地区医院，并且遣返协议必须优先考虑区域患者而不是辐射医院的其他目标，以促进枢纽医院的容量。
