Background and purpose There is considerable interest among existing stroke hospitals to add endovascular thrombectomy (EVT) capability as a means to attract and retain stroke patient referrals. In this work, we quantify changes in patient volumes when adding EVT capability to an existing stroke center.
Methods In MATLAB 2017a Simulink, we simulated adding EVT capability to an existing primary stroke center (PSC) in a system comprising one PSC and one comprehensive stroke center (CSC), using a three different routing paradigms. In the Nearest Center paradigm, patients are initially sent to the nearest center regardless of capability, while in EVT First, patients are sent to the nearest EVT-capable center. In Rhode Island, patients with FAST-ED ≥4 are sent to an EVT-capable center, while the others are sent to the nearest center.
Results In EVT First, adding EVT capability to a PSC increases patient capture by the PSC from 0% to 66.58% within its service area, representing an increase from 0% to 22.09% receiving IV tPA only, 0% to 8.25% receiving EVT only, 0% to 23.15% receiving IV tPA and EVT, and 0% to 13.09% receiving neither. In Rhode Island, adding EVT capability increases patient capture by the PSC from 5.45% to 66.58%, representing an increase from 3.68% to 22.09% receiving IV tPA only, 0% to 8.25% receiving EVT only, 0% to 23.15% receiving IV tPA and EVT, and 1.72% to 13.09% receiving neither. In Nearest Center, adding EVT capability maintains patient capture by the PSC at 66.58% and retains 29.44% of patients that would otherwise transfer for EVT.
Conclusion Adding EVT capability to an existing PSC can dramatically shift patient volume from existing EVT capable centers, especially with routing models that permit bypass of nearby hospitals for more capable centers. These data may inform clinical and financial planning efforts at stroke centers considering adding EVT capability.
Disclosures M. Zhou: None. A. Kansagra: None.
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