Stroke Mapping

Improving access to mechanical thrombectomy

Our hospital recently opened a neuro~endovascular department to treat patients with mechanical thrombectomy. Similar efforts have been undertaken in other major public hospitals in the Attica region (comprising Athens) in the last 2 years. It has been estimated that around 240 acute stroke patients per annum per million population are eligible for endovascular treatment (EVT). With a population of 3.8 million people, the Attica region is estimated to have more than 900 patients eligible for EVT annually. However, only a minority of these patients receive EVT, no more than 200 per year in the whole country of more than 10 million inhabitants.

Reasons behind the slow adoption of EVT in Greece

In the Attica region and all major Greek cities, public hospitals do not provide continuous emergency care. Emergency departments treat patients 1 in 4 days, meaning that each day there is one major and some minor public hospital admitting acute stroke patients.

This system of rotating service:
• does not permit the development of a comprehensive stroke center to provide 24/7/365 acute stroke care.
• means at least 4 stroke centers are needed to provide continuous care (hospitals “on duty” one every four days)

As a consequence, many physicians admitting stroke patients in small volume hospitals lose time to identify which EVT center is on duty and protocols for drip-and-ship treatments to these centers have not yet been implemented.

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Years Experience

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Publications

Objective

Build a free Android app and a website that map intravenous thrombolysis (IVT) units and endovascular treatment (EVT) centers on a national scalec

This application will provide anonymous data collection that may be used as a quality improvement tool. Reports of the data may be used to identify gaps in care and improve patient access to acute stroke recanalization therapies.

Presentation of the Development app team

The app has been developed by Medlab, Head Prof Fotiadis, Professor of Biomedical Engineering and Director of the Unit of Medical Technology and Intelligent Information Systems (MEDLAB: https://medlab.cc.uoi.gr/), University of Ioannina, Greece. Medlab will develop the Greek version of the application.

Presentation of the application

The app will provide a national mapping tool based on Google maps with continuously updated information on IVT Units/EVT Centers. The app will provide emergency care physicians with real-time information on available stroke services to expediate transfer of acute stroke patients to the nearest treating Unit/Center.

Given the restricted availability of resources and personnel in many public hospitals, these maps will be continuously updated to provide reliable information to guide acute stroke patient transfers. Mapping resource availability will accelerate implementation of stroke treatment guidelines and will provide the necessary framework to improve comprehensive stroke care.

Regular update of availability

A neurologist of our department will confirm availability for the upcoming week with all EVT centers and will record data on treated/transferred patients. IVT and EVT leaders in each Unit/Center will be trained to use the app to update their availability.

Continually covering stroke treatment will encourage physicians to consider IVT/EVT standard of care and this will ultimately lead to more referrals.

Project Phases

1. Data Collection and Launch:

(a.) Promote the application among healthcare professionals. (c.) Collect initial data on stroke cases and center locations. (d.) Repeat effective strategies in each new center.

2. Data Analysis and Refinement:

(a) Analyze collected data for trends and insights. (b) Identify areas for improvement in stroke care. (c) Refine the application based on user feedback.

3. Expansion and Customization:

Develop a strategy to expand the application to more centers. Collaborate with local stakeholders for integration in existing systems of care and ongoing initiatives.

4. Awareness and Membership Growth:

Launch awareness campaigns through national congresses and social media about the application’s benefits.

5. Continuous Improvement and Impact Assessment:

Regularly update the application with new data. Assess the impact of the application on stroke care. Collect testimonials and success stories from users.

Key Milestones

Project Kickoff and Team Consolidation

(Months 1-3)

a. Find interested local coordinators in all EVT Centers and IVT Units in Attica.

b. Make schedules of rotating shifts incorporating angio/personnel availability

c. Finalize details

d. Present app in testing mode in the National Stroke Conference in Athens.

Application Launch in Attikon University Hospital (EVT Center) and IVT Units

(Months 3-6)

a. Review before launch

b. App goes live to more EVT Centers/IVT Units

Expansion to additional Centers/Units outside the Attica region

(Months 6-9)

a. Status and tracking

b. Dissemination to more EVT Centers and IVT Units

c. Expansion to prefectures around Attica (within 2 hours from Athens by car): Viotia, Corinth, Evia Regional Hospitals. Local physicians not yet contacted.

d. Expansion to EVT centers of the periphery: Thessaloniki, Patras, Larissa, Herakleion, Alexandroupolis in collaboration with the corresponding Neurology University Clinics. Most Head of Clinics already informed of the program and support it.

Project performance and monitoring

a. Data Collection and Analysis Completion (Months 12-15)

b. Repeat launch in remote areas to provide full national coverage (Months 12-18)

c. Impact Assessment and Report publication (Months 13-15)

d. Continuous Improvement and Updates (Ongoing)

Specific and measurable objectives

1. By the end of the first year after the application’s release (November 2025), achieve use in clinical practice in 10 EVT Centers, 20 IVT Units and 30 non-treating clinics. Special focus of promoting use of the app will first be given in the Attica Region.

2. Within 12 months of the application’s launch (November 2025), collect anonymized data from a minimum of 100 stroke cases across participating centers. Analyze this data to identify trends in patient trajectories, treatment outcomes, and areas for improvement in stroke care delivery.

3. At the end of the 18-month program (May 2026) assess application’s contribution to participating centers through surveys and registration data.

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