Janet E Bray1, Sonia Denisenko2, Bruce C V Campbell3, Michael Stephenson4,5, Jason Muller4, Grant Hocking4, Peter J Hand2,3, Christopher F Bladin6,7. 1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 2. Department of Health and Human Services, Victorian Stroke Clinical Network, Melbourne, Victoria, Australia. 3. Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia. 4. Ambulance Victoria, Melbourne, Victoria, Australia. 5. Department of Community Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia. 6. The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia. 7. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: In 2010, rapid access to stroke thrombolysis centres was limited in some regional areas in the Australian state of Victoria. These results, and planning for endovascular clot retrieval (ECR), have led to the implementation of strategies by the Victorian Stroke Clinical Network, the Victorian Stroke Telemedicine Program and local health services to improve state-wide access. AIMS: To examine whether access to stroke reperfusion services (thrombolysis and ECR) in regional Victoria have subsequently improved. METHODS: The locations of suspected stroke patients attended by ambulance in 2015 were mapped, and drive times to the nearest reperfusion services were calculated. We then calculated the proportion of cases with transport times within: (i) 60 min to thrombolysis centres; and (ii) 180 min to two ECR centres designated to receive regional patients. Statistical comparisons to existing 2010 data were made. RESULTS: In 2015, Ambulance Victoria attended 16 418 cases of suspected stroke (2.9% of all emergency calls), of whom 4597 (28%) were located in regional Victoria. Compared to 2010, a greater proportion of regional suspected stroke patients in 2015 were located within 60 min of a thrombolysis centre by road (77-95%, P < 0.001). A 3-h road travel time to the two ECR centres is currently possible for 88% of regional patients. CONCLUSION: A strategic and region-specific approach has resulted in improved access by road transport to reperfusion therapies for stroke patients across Victoria.
BACKGROUND: In 2010, rapid access to stroke thrombolysis centres was limited in some regional areas in the Australian state of Victoria. These results, and planning for endovascular clot retrieval (ECR), have led to the implementation of strategies by the Victorian Stroke Clinical Network, the Victorian Stroke Telemedicine Program and local health services to improve state-wide access. AIMS: To examine whether access to stroke reperfusion services (thrombolysis and ECR) in regional Victoria have subsequently improved. METHODS: The locations of suspected strokepatients attended by ambulance in 2015 were mapped, and drive times to the nearest reperfusion services were calculated. We then calculated the proportion of cases with transport times within: (i) 60 min to thrombolysis centres; and (ii) 180 min to two ECR centres designated to receive regional patients. Statistical comparisons to existing 2010 data were made. RESULTS: In 2015, Ambulance Victoria attended 16 418 cases of suspected stroke (2.9% of all emergency calls), of whom 4597 (28%) were located in regional Victoria. Compared to 2010, a greater proportion of regional suspected strokepatients in 2015 were located within 60 min of a thrombolysis centre by road (77-95%, P < 0.001). A 3-h road travel time to the two ECR centres is currently possible for 88% of regional patients. CONCLUSION: A strategic and region-specific approach has resulted in improved access by road transport to reperfusion therapies for strokepatients across Victoria.
Authors: Ana Barragán-Prieto; Soledad Pérez-Sánchez; Francisco Moniche; Roberto Valverde Moyano; Fernando Delgado; Patricia Martínez-Sánchez; Miguel Moya; Juan M Oropesa; Adolfo Mínguez-Castellanos; Inmaculada Villegas; María José Álvarez Soria; Jose Antonio Tamayo Toledo; Carlos de la Cruz Cosme; Rafael Canto Neguillo; Juan Manuel Herrerías Esteban; Daniel José Montero Cobos; Jose Antonio Moreno Muñoz; Alejandro González; Joan Montaner Journal: Eur Stroke J Date: 2022-05-25