RT Journal Article
SR Electronic
T1 Evaluation of direct-to-angiography suite (DTAS) and conventional clinical pathways in stroke care: a simulation study
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1189
OP 1194
DO 10.1136/neurintsurg-2021-018253
VO 14
IS 12
A1 Mehrad Bastani
A1 Timothy G White
A1 Gabriela Martinez
A1 Joseph Ohara
A1 Kinpritma Sangha
A1 Michele Gribko
A1 Jeffrey M Katz
A1 Henry H Woo
A1 Artem T Boltyenkov
A1 Jason Wang
A1 Elizabeth Rula
A1 Jason J Naidich
A1 Pina C Sanelli
YR 2022
UL http://jnis.bmj.com/content/14/12/1189.abstract
AB Background Rapid time to reperfusion is essential to minimize morbidity and mortality in acute ischemic stroke due to large vessel occlusion (LVO). We aimed to evaluate the workflow times when utilizing a direct-to-angiography suite (DTAS) pathway for patients with suspected stroke presenting at a comprehensive stroke center compared with a conventional CT pathway.Methods We developed a discrete-event simulation (DES) model to evaluate DTAS workflow timelines compared with a conventional CT pathway, varying the admission NIHSS score treatment eligibility criteria. Model parameters were estimated based on 2 year observational data from our institution. Sensitivity analyses of simulation parameters were performed to assess the impact of patient volume and baseline utilization of angiography suites on workflow times utilizing DTAS.Results Simulation modeling of stroke patients (SimStroke) demonstrated door-to-reperfusion time savings of 0.2–3.5 min (p=0.05) for a range of DTAS eligibility criteria (ie, last known well to arrival <6 hours and National Institutes of Health Stroke Scale ≥6–11), when compared with the conventional stroke care pathway. Sensitivity analyses revealed that DTAS time savings is highly dependent on baseline utilization of angiography suites.Conclusions The results of the SimStroke model showed comparable time intervals for door-to-reperfusion for DTAS compared with a conventional stroke care pathway. However, the DTAS pathway was very sensitive to baseline angiography suite utilization, with even a 10% increase eliminating the advantages of DTAS compared with the conventional pathway. Given the minimal time savings modeled here, further investigation of implementing the DTAS pathway in clinical care is warranted.Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.