Abstract DP254: Improving Stroke Treatment by Integrating Hospital-Specific Door-to-Needle Times into Prehospital Routing

Introduction: In acute ischemic stroke (AIS), the time from symptom onset to initiation of recanalization therapy, such as intravenous thrombolysis (IVT), is a major determinant of functional outcome. The door-to-needle time (DNT) is a quality indicator in stroke care and a shorter DNT is associated with improved outcomes. While DNT vary considerably across hospitals, this information is not available in the prehospital setting; therefore, hospital selection is currently based primarly on the shortest transportation time. We hypothesized that overall time from first medical contact to IVT administration could be reduced by directing patients to centers with shorter DNTs, even at the expense of longer transport time. Methods: The region of Eastern Saxony, as an exemplary area, was projected onto a grid. Each cell was then assigned an exact population using data provided by german authorities. All stroke care providing hospitals were projected to the resulting grid. By utilizing a self developed OpenSourceRoutingMachine derived software the fastest drive time was then calculated using OpenStreetMap data. Median DNTs were available for all stroke care providers. Catchment areas were calculated by tensor minima by drive time alone and after adding the corresponding DTN per hospital to the transportation time tensors. Finally, the DTNs were assigned to the resulting catchment areas. Results: The simulated region of interest comprised 798,715 individual cells with a total population of 1,582,254. Stroke care is provided by 22 hospitals, including 9 neurological centers and 13 telemedical units with DNT between 30 and 90 min. Without optimization, the median transportation time was 17 min (IQR 12-23). The simulated median DNT under this scenario was 54 min (IQR 37-68). With DTN optimization, median drive time increased to 24 min (IQR 16–32), while the simulated DNT decreased to 34 min (IQR 31–37). Conclusions: Using a calculation model for intelligent route planning when admitting patients with AIS, depending on hospital-specific DNT, resulted in imposing time savings at the start of treatment. However, before implementing such a strategy, the resulting shifts in catchment areas and subsequent changes in patient volumes per hospital would need to be considered. This could incentivise improvements in acute care and enable financial resources to be allocated more effectively.