Workflow optimization pre and in hospital by Dr. Marc RIBO - SLICE Worldwide 2021

The doctor Marc Ribo’s talking about the organization networks for Stroke Management in the Vall d'Hebron University Hospital in Barcelona. So this hospital, it’s a priority to send people where they belong. 

Pre Hospital:

The paramedic’s job is to know what is going on with the patient, they should be able to know a maximum of information according to the situation. But they are seeing a lot of patients every day, they can’t be Stroke Expert, so the doctor created a road map, a simplified version of the NIHSS that can be performed by professional with just a little training. It helps to measure a problem so they can send the information and help the doctor to prepare himself for the intervention.

Where should we send the patient?

When you’re a paramedic with a patient with a suspected stroke, you need to know where to send him. The closest Stroke Center or the further comprehensive stroke center or to any hospital? Not all hospital are certified stroke centers, they are not prepared for that. But you need to drive somewhere. You need to make the better choice so the patient can have better chance of survival. 

Mobile Stroke Units

Sometimes the hospital sent Mobile Stroke Units because it will be better to save time. But there are advantages and inconvenient. Maybe if that could help a lot of people. This setup is highly expensive (1 million dollars for 1 setup). Also, you need to know where to place it to be the most efficient. So, it’s a tricky situation. But the studies show that the earlier the patient receive the Iv-TPA, the better are his chance to survive.

Pre-Admission

Ideally, you bring the patient to the local stroke center, so they can perform the images. You start the IV TPA and you ask the ambulance to stay in case you need to move the patient to another hospital (by doing that you can save 30 minutes). The ideal is to join the next hospital in 45 minutes. But most of the time it will take something like 90 or more.

This study shows that there is too much time in the pre-hospital part around 60% and only 40% in the hospital. Because of the travel who’s taking almost 1 hour per patient. The goal is to spend 30 minutes maximum outside the hospital.