Abstract Details

Title Mobile Stroke Unit Operation in a Topographically Variable County

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-001

Objective This study describes process improvements made to ensure successful and efficient treatment of stroke patients on a Mobile Stroke Unit (MSU) in a topographically variable environment.

Background MSUs require a level surface for CT scanner operation. The MSU is equipped with a user-friendly leveling system which can compensate for a front-to-back maximum angle of 3.8° (6.6% grade), and a left-to-right maximum angle of 10.4° (18.4% grade), but still requires the unit be parked on a relatively flat surface. Previous reports of MSU operations have been from topographically flat and fairly uniform communities. In San Mateo County, many neighborhoods are topographically variable, making access challenging.

Design/Methods A workflow change was instituted to adapt to locations which the MSU either could not directly access due to size, or at which the grade was greater than the internal leveling system could accommodate. For particularly hilly areas, pre-specified “staging” locations were identified. These locations had flat grade, adequate space for the MSU, required minimal additional driving time en-route to destination hospital. The MSU team evaluates the patient at the original location, and takes the patient onboard the MSU if the patient meets criteria for transport. Then, the MSU drives with the patient to the pre-specified “staging” location, where the CT scan is performed and rt-PA treatment decision is made.

Results Employing this process improvement eliminated additional on-scene time spent identifying a more level location. Clear algorithms allow for smooth workflow and limit delays to treatment. Additionally, in hilly areas, cellular service is often unreliable, so traveling to a “staging” location has often improved connectivity for telemedicine.

Conclusions This study is the first to describe a standardized workflow solution to challenging topography. As MSUs become more prevalent, reproduction of this process may prove useful to other counties facing similar challenges, while improved leveling capabilities are being concurrently developed.

Authors/Disclosures
Ilana Spokoyny, MD (Sutter West Bay Medical Group) PRESENTER	Dr. Spokoyny has nothing to disclose.
Joey English, MD, PhD	No disclosure on file
	No disclosure on file
Jorge Delgadillo (Mills Peninsula Medical Center)	No disclosure on file
	No disclosure on file
	No disclosure on file
nobl barazangi, MD, PhD	Dr. Barazangi has nothing to disclose.

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Abstract Details