• Chun-Han Wang, Ting-Yu Liu, Wen-Chu Chiang, Sung-Chun Tang, Li-Kai Tsai, Chung-Wei Lee, Yen-Heng Lin, Jiann-Shing Jeng, Matthew Huei-Ming Ma, Ming-Ju Hsieh, and Yu-Ching Lee.
• Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan.
• J Formos Med Assoc. 2022 May 1; 121 (5): 978-985.

Background/PurposeRecently optimized models for selecting the locations of hospitals capable of providing endovascular thrombectomy (EVT) did not consider the accuracy of the prehospital stroke scale assessment and possibility of secondary transport. Our study aimed to propose a new model for selecting existing hospitals with intravenous thrombolysis capability to become EVT-capable hospitals.MethodsA sequential order was provided to upgrade hospitals providing intravenous thrombolysis, using a mixed integer programming model based on current medical resource allocation. In addition, we drafted a centralized plan to redistribute existing EVT resources by redetermining locations of EVT-capable hospitals. Using historical data of 7679 on-scene patients with suspected stroke, the model was implemented to determine the hospital that maximizes the number of patients receiving EVT treatment within call-to-definitive-treatment time.ResultsAll suspected stroke patients were sent to EVT-capable hospitals directly under the current medical resource allocation model. After upgrading one additional hospital to become an EVT-capable hospital, the percentage of patients receiving definitive treatment within the standard call-to-definitive-treatment time was elevated from 68.82% to 72.97%. In the model, assuming that there is no hospital providing EVT, all patients suspected of stroke will be sent to EVT-capable hospitals directly after upgrading three or more hospitals to be able to provide treatment.ConclusionAll patients eligible for acute stroke treatment are sent to EVT-capable hospitals in the simulation under the current medical resource allocation model. This model can be utilized to provide insights for capacity redistribution in other regions.Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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