Deans' stroke musings: Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, May 18, 2022

Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis

I don't consider mobile stroke units much of an improvement except as a talking point for hospitals. If your hospital is touting this then they aren't addressing the only goal in stroke, 100% RECOVERY.

But still not fast enough to get to 100% recovery. Since they are not measuring 100% recovery, they don't give a shit about getting there.

“What's measured, improves.” So said management legend and author Peter F. Drucker

The latest here:

Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis

Nathaniel R. Ellens¹,

Derrek Schartz²,

Redi Rahmani¹,

Sajal Medha K. Akkipeddi¹,

Adam G. Kelly³,

Curtis G. Benesch³,

Stephanie A. Parker⁴,

Jason L. Burgett¹,

Diana Proper¹,

Webster H. Pilcher¹,

Thomas K. Mattingly¹,

James C. Grotta⁵,

Tarun Bhalla¹ and

Matthew T. Bender¹^*

¹Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States
²Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States
³Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
⁴Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
⁵Mobile Stroke Unit, Memorial Hermann Hospital—Texas Medical Center, Houston, TX, United States

Background: The available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance.

Methods: Our MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours (“per day”), mechanical thrombectomy (MT)/dispatch and MT/day.

Results: Our MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150–0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074–0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8–9.5%, I² = 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215–0.502, I² = 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2–2.8%, I² = 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046–0.138, I² = 91%).

Conclusions: In this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs.

Introduction

Since mobile stroke units (MSU) were first described in 2003 in Germany, numerous studies have shown MSU care expedites intravenous thrombolysis and mechanical thrombectomy compared to standard emergency medical services (1–7). Recently, two large, prospective controlled trials have shown improved clinical outcomes 90 days after presentation with acute ischemic stroke in patients receiving MSU care as compared to traditional emergency medical services (8, 9). These compelling data have raised the question, “Does My District Need a Mobile Stroke Unit?” (10).

Because MSU operations require significant personnel and material resources, cost-effectiveness and viability will vary with local circumstances (11). The decision to establish a mobile stroke unit must be made in consideration of local case volume, geography, and infrastructure. The purpose of this manuscript was to establish standard metrics for reporting MSU operational efficiency and to benchmark those numbers using our institutional experience and a meta-analysis of the current literature.