Beschreibung:
<jats:sec><jats:title>Objectives</jats:title><jats:p>The policy of centralising hyperacute stroke units (HASUs) in England aims to provide stroke care in units that are both large enough to sustain expertise (>600 admissions/year) and dispersed enough to rapidly deliver time-critical treatments (<30 min maximum travel time). Currently, just over half (56%) of patients with stroke access care in such a unit. We sought to model national configurations of HASUs that would optimise both institutional size and geographical access to stroke care, to maximise the population benefit from the centralisation of stroke care.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Modelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>127 acute stroke services in England, serving a population of 54 million people.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>238 887 emergency admissions with acute stroke over a 3-year period (2013–2015).</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>Modelled reconfigurations of HASUs optimised for institutional size and geographical access.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measure</jats:title><jats:p>Travel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Solutions were identified with 75–85 HASUs with annual stroke admissions in the range of 600–2000, which achieve up to 82% of patients attending a stroke unit within 30 min estimated travel time (with at least 95% and 98% of the patients being within 45 and 60 min travel time, respectively).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The reconfiguration of hyperacute stroke services in England could lead to all patients being treated in a HASU with between 600 and 2000 admissions per year. However, the proportion of patients within 30 min of a HASU would fall from over 90% to 80%–82%.</jats:p></jats:sec>