Year: 2025
Type: article
Study design: Observational Study
Abstract: Study Objectives: In March 2024 the Dublin Midland Hospital Group and National Ambulance Service introduced a Hyperacute FAST+ ambulance bypass protocol for patients who are normally in the catchment area of two regional hospitals (Naas General Hospital and Midland Regional Hospital, Portlaoise) in the Leinster region of Ireland.Paramedics are empowered to bring patients with a hyperacute FAST+ presentation in these catchment areas to Tallaght University Hospital (TUH) an academic tertiary hospital to expedite specialist stroke care.The regional hospitals are located 28km and 76km respectively from the academic tertiary hospital.This study aimed to describe the resource burden on the academic tertiary hospital emergency department (ED) and to quantify the patient journey times.Methods: In this single center retrospective chart review, all Hyperacute FAST+ patient presentations to TUH ED between March 1, 2024 and February 28, 2025 were reviewed and analyzed using data from the ED Information System Symphony.Journey times and distances were collated using Google Maps.Results: There were 62,728 attendances to TUH ED in the study period and of these 13,403 patients presented to TUH ED by ambulance.1.2% (n¼162) of ambulance attendances were patients presenting on the out of catchment Hyperacute FAST+ patients protocol during the study period.The mean age was 68 years.There were 93 males and 69 females.The mean travel distance was 54.9km and an estimated travel time of 44 minutes.The mean ED patient experience time was 5.1 hours.56.2% (n¼91) of patients were admitted to TUH while 43.8% (n¼71) were discharged from ED. 9.9% received thrombolysis and 5.6% received thrombectomy.4.3% (n¼3) patients were referred onwards to the regional neurosurgical center, 29.6% (n¼21) patients were discharged home directly and 66.2% (n¼47) were repatriated back to the regional hospitals for medical admission.The mean length of stay for the patients admitted to the academic tertiary hospital was 13.6 days.Conclusion: This single health region Hyperacute FAST+ bypass protocol resulted in high admission rates and hospital length of stay in the regional stroke center.The ambulance journey times in this study are long.Time to imaging and senior decisionmaking for thrombolysis is at an appropriately trained consultant level is critical.The future and optimal model for Hyperacute FAST+ assessment and gold standard endovascular thrombectomy treatment in Ireland is continuously developing and will be influenced by geographical considerations, manpower and ambulance resources and will be better informed by both ongoing national and international research.
Source: Annals of Emergency Medicine
Authors: L. Perry, S. Mooney, D. Irwin, D. Ryan, A. McCabe, R. Riordon
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,850
OpenAlex ID: W4413433366