RT Journal Article
SR Electronic
T1 Hub-and-spoke model for thrombectomy service in UK NHS practice
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP e26
OP e31
DO 10.7861/clinmed.2020-0579
VO 21
IS 1
A1 Liqun Zhang
A1 Ayokunle Ogungbemi
A1 Sarah Trippier
A1 Brian Clarke
A1 Usman Khan
A1 Claire Hall
A1 Qiuhong Ji
A1 Andrew Clifton
A1 Gillian Cluckie
YR 2021
UL http://www.rcpjournals.org/content/21/1/e26.abstract
AB Mechanical thrombectomy is a highly effective but time dependent treatment for acute ischaemic stroke due to large vessel occlusion. In the UK, the national clinical guidelines for stroke and National Institute for Health and Care Excellence guidance endorses thrombectomy as an acute stroke treatment, and NHS England commissioned thrombectomy services. However, there are no UK ‘real-world’ data to verify the efficacy of the hub-and-spoke model in thrombectomy. There are currently 24 tertiary neuroscience centres in the UK that can provide thrombectomy treatment and many of these operate only within working hours. This study is the first to demonstrate that a hub-and-spoke thrombectomy service in routine UK 24/7 clinical practice is as effective and safe as in the setting of randomised controlled clinical trials. However, there are 9.3% of patients accepted for transfer to the thrombectomy centre who did not proceed to thrombectomy, mostly due to delays. Fifty-three per cent of thrombectomy cases were performed outside of standard working hours when transfer delays were increased. A 24/7 thrombectomy service is needed to maximise the benefit to all suitable patients. Measures, including improving workflow and optimising work forces, are needed to minimise the delays and continue to improve the service.