Editorials

Hyperacute stroke care and NHS England’s business plan

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3049 (Published 02 May 2014) Cite this as: BMJ 2014;348:g3049
  1. Thomas Monks, research fellow1,
  2. Martin Pitt, associate professor1,
  3. Ken Stein, professor of public health1,
  4. Martin A James, consultant stroke physician2
  1. 1National Institute for Health Research Collaboration in Leadership and Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter EX2 4SG, UK
  2. 2Royal Devon and Exeter Hospital, Exeter, UK
  1. t.monks{at}exeter.ac.uk

Computer simulation, coupled with high quality data, can help in decision making

NHS England’s refreshed business plan identifies the reconfiguration of hyperacute stroke services as a priority. NHS England aims to develop the case for major reconfigurations in two further geographical locations by April 2015.1 This priority follows the centralisation of London’s acute stoke care in 2010, in which 30 local hospitals receiving stroke patients were reduced to eight hyperacute stroke units, each within a maximum ambulance travel time of 30 minutes. In a before and after study,2 the thrombolysis rate increased from 5% to 12%, the survival rate increased from 87.2% to 88.7%, and centralisation achieved an estimated 90 day cost saving of more than £5m (€6.1; $8.4m) a year.

Improvements have continued, with 2013 audit data for London reporting a thrombolysis rate of 17% and median door to needle times ranging from 29 to 48 minutes compared with an English average of 12% and median 59 minutes, respectively.3 Given London’s success, an important question arises for many NHS commissioners: would such a reconfiguration be just as effective outside the major conurbations?

Central to this question is the exquisitely time sensitive …

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