Decision support in pre-hospital stroke care operations: A case of using simulation to improve eligibility of acute stroke patients for thrombolysis treatment

Stroke is the third most common cause of death and the sixth most common cause of disability worldwide. Treating acute ischemic stroke with thrombolytic therapy within 4.5 hours from symptom onset is effective in improving patient outcomes. The time from stroke onset to arrival to hospital has been identified as the single most important issue in determining patients' eligibility for stroke thrombolysis. There is a need for simultaneous systemic evaluation of multi-factorial interventions in pre-hospital acute care systems, aimed at increasing patients' eligibility for stroke thrombolysis. In this paper an OR solution is proposed in the form of a simulation model that provides clear measure of the relative benefit of alternative potential interventions, demonstrating how OR modeling can be used for providing decision support in pre-hospital stroke care operations and contributing to health OR literature. (C) 2012 Elsevier Ltd. All rights reserved.