Huang Shiwei, Maingard Julian, Kok Hong Kuan, Barras Christen D, Thijs Vincent, Chandra Ronil V, Brooks Duncan Mark, Asadi Hamed
The Canberra Hospital, Canberra, ACT, Australia.
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, VIC, Australia.
Front Neurol. 2019 Jun 27;10:653. doi: 10.3389/fneur.2019.00653. eCollection 2019.
Endovascular clot retrieval (ECR) is the standard of care for acute ischemic stroke due to large vessel occlusion. Performing ECR is a time critical and complex process involving many specialized care providers and resources. Maximizing patient benefit while minimizing service cost requires optimization of human and physical assets. The aim of this study is to develop a general computational model of an ECR service, which can be used to optimize resource allocation. Using a discrete event simulation approach, we examined ECR performance under a range of possible scenarios and resource use configurations. The model demonstrated the impact of competing emergency interventional cases upon ECR treatment times and time impact of allocating more physical (more angiographic suites) or staff resources (extending work hours). Our DES model can be used to optimize resources for interventional treatment of acute ischemic stroke and large vessel occlusion. This proof-of-concept study of computational simulation of resource allocation for ECR can be easily extended. For example, center-specific cost data may be incorporated to optimize resource allocation and overall health care value.
血管内血栓清除术（ECR）是治疗因大血管闭塞导致的急性缺血性卒中的标准治疗方法。实施ECR是一个时间紧迫且复杂的过程，涉及许多专业护理人员和资源。在使患者受益最大化的同时将服务成本降至最低，需要优化人力和物力资产。本研究的目的是开发一种ECR服务的通用计算模型，该模型可用于优化资源分配。我们采用离散事件模拟方法，研究了一系列可能场景和资源使用配置下的ECR性能。该模型展示了竞争性急诊介入病例对ECR治疗时间的影响，以及分配更多物力资源（更多血管造影套件）或人力资源（延长工作时间）对时间的影响。我们的DES模型可用于优化急性缺血性卒中和大血管闭塞介入治疗的资源。这项关于ECR资源分配计算模拟的概念验证研究可以很容易地扩展。例如，可以纳入特定中心的成本数据，以优化资源分配和整体医疗保健价值。
