Background: Rapid treatment of acute ischemic stroke (AIS) is key to improving outcomes, yet pre-hospital transportation decisions are rarely considered. Decisions on acute care destinations for AIS patients are often poorly guided and based on patient preference. In a complex urban environments with multiple stroke centers, proper guidance these decisions may reduce delays in treatment. We hypothesize that the integration of stroke center quality metrics and traffic patterns into pre-hospital transportation of AIS patients would reduce treatment times.
Methods: Travel times to Duke University Hospital (DUH) and Duke Raleigh Hospital (DRAH) from three locations (RDU airport, Falls Lake, Apex town center) were examined at 5 times of day (2AM, 8AM, 12PM, 5:30PM, 8PM) taking traffic delays into account using Google Maps estimates from historical data. Average door-to-needle times (DTN) for each hospital were obtained for the prior 6 months. The 6 month average DTN as well as individual monthly averages were added to travel times to simulate stroke-onset-to-needle times (ONT) for hypothetical patients transported from each location to each hospital.
Results: The six-month average DTN were 59.8 mins (DUH) and 64.8 mins (DRAH). Based on these times, patients originating from RDU or Falls Lake have shorter estimated ONT at DUH, regardless of time of day and despite greater geographical distances. Patients transported from Apex had shorter ONT at DRAH except at 5:30PM, when ONT at DUH was estimated 5.5 mins faster. In June alone, average DTN were 44 mins (DUH) and 55 mins (DRAH). Simulated patients transported during this month had faster ONT at DUH when traveling from any of the three locations and at any time of day examined, again despite greater geographic distances or longer transport times.
Conclusion: In this proof of concept model, integrating DTN averages and traffic patterns into transportation of AIS patients demonstrated instances when traveling further geographical distances reduced ONT. This emphasizes the need to develop regional and statewide integrated systems of care, which may reduce reperfusion times, and improve quality of care.