Improving Patient Transfer Protocols for Regional Stroke Networks

Currently, stroke patients are transported to the nearest stroke center, following specific protocols. Yet, these protocols do not consider many factors, including the spatial variation in population density, the stroke???s severity, the time since stroke onset, and the congestion level at the receiving stroke center. We develop an analytical framework that enriches the stroke transport decision-making process by incorporating these factors. Our research contributes to the literature of stroke care systems by (i) developing the first analyt-ical framework to determine the optimal primary hospital destination in a regional stroke network and (ii) comparing the impact of incorporating prehospital triaging on health out-comes. To this end, we develop an efficient reformulation for allocation problems with sto-chastic demand and multiserver system under congestion. We derive data-driven outcome prediction models embedded in mixed integer second-order cone programming formula-tion. Our framework is applied to two real-life cases: Montreal and Quebec City Stroke Net-works. We show that adopting a triage strategy could lead to significantly improved health outcomes, where the magnitude of these improvements varies with the networks??? sizes and congestion levels. In the Montreal case, our proposed policy may increase the ratio of pa-tients for therapeutic intervention eligibility by 12.5% while improving by 69% the number of patients with more than two days of emergency department boarding delays. Our results reveal that it is important to consider the network???s characteristics in making a decision for or against implementing a prehospital triage strategy. Finally, we propose a heuristic policy that provides a promising performance while also being easy to implement.

Automated summary

This article introduces an analytical framework for selecting the optimal hospital destination for stroke patients and compares the impact of implementing a prehospital triage strategy on health outcomes. The research findings show that adopting a triage strategy can significantly improve health outcomes, but the magnitude of improvement varies with the size and congestion level of the network.