Dutta Dipankar, Parry Frances, Obaid Mudhar, Ramadurai Gopinath
Gloucestershire Royal Hospital, Gloucester, UK.
Future Healthc J. 2020 Feb;7(1):65-71. doi: 10.7861/fhj.2019-0003.
Mechanical thrombectomy (MT) is a very effective, but highly time dependent, reperfusion technique in the management of acute ischaemic stroke caused by large artery occlusion. MT is provided by 24 neuroscience centres (NSCs) in the UK which receive patients directly ('mothership') and via transfer from district general hospitals (DGHs), the 'drip and ship' pathway. NSCs currently provide a within hours service but are working on service expansion to enable 24/7 availability. DGHs, too, will need to prepare for this service expansion to ensure good outcomes for their patients. We discuss options for service expansion in a DGH and regional stroke network in south-west England and use Sentinel Stroke National Audit Programme data and discrete event simulation to model and compare alternative workflow options to aid the planning process. We suggest that our modelled options could be considered by all NHS DGHs in their preparation for MT service expansion.
机械取栓术（MT）是治疗由大动脉闭塞引起的急性缺血性卒中时一种非常有效的再灌注技术，但时间依赖性很强。英国有24个神经科学中心（NSCs）提供MT，这些中心直接接收患者（“母舰”模式），并通过从地区综合医院（DGHs）转运接收患者，即“点滴转运”途径。NSCs目前提供数小时内的服务，但正在努力扩大服务范围以实现全天候可用。DGHs也需要为这项服务扩展做好准备，以确保其患者获得良好的治疗效果。我们讨论了英格兰西南部一个DGH和区域卒中网络中服务扩展的选项，并使用哨兵卒中国家审计计划数据和离散事件模拟来建模和比较替代工作流程选项，以辅助规划过程。我们建议，所有国民保健服务DGHs在为MT服务扩展做准备时都可以考虑我们建模的选项。
