Adaptive performance of the Tuscany Stroke Network to the COVID-19 outbreak: a retrospective study.

AIMS. Faced with the burden of stroke, a regional strategy was implemented in Tuscany at the beginning of 2015. A hub-and-spoke model was established throughout tuscanian stroke hospitals adopting a common protocol to standardize acute ischemic stroke (AIS) care, leading to the implementation of the Tuscany Stroke Network (TSN). AIS patients are first taken to the nearest spoke hospital for possible t-PA treatment, assessed for eligibility to endovascular intervention, and quickly transferred to the nearest hub hospital, where appropriate. We investigated differences in quantity of revascularization treatments for AIS patients before and after the TSN implementation, to explore and monitor its effectiveness. MATERIALS AND METHODS. This interventional study was conducted from January 1, 2014 to December 31, 2018 and included all patients with AIS consecutively treated in each of the 22 TSN hospitals. Before and after analysis was conducted using data covering the entire region.We estimated an expected number of 9000 AIS patients per year. We measured TSN efficacy by estimating and comparing annual numbers and rates of AIS treatments, as well as health benefits in terms of Disability Adjusted Life Years (DALYs) avoided , based on 0,605 DALYs avoided for each treated patient, before (2014) and after (2015-2018) TSN implementation. RESULTS. The network spans across 23000 Km2 with 3,8 million inhabitans, 26 hospitals with no stroke service, 3 hub hospitals and 19 spoke hospitals. Through 2014, 382 AIS patients were treated, mainly with t-PA. Number and rates of treatments increased up to 669 (7,4%) in 2015 and to 1312 (14,6%) in 2018. The implementation of the TSN resulted in 1549 additional patients treated with t-PA from 2015 to 2018, yielding to an health benefit of 937,1 DALYs avoided. An increasing number of both secondary tranfers have been activated, yielding to an increasing number of endovascular treatments performed eventually by the hub hospitals throughout the observation period. DISCUSSION. The logistic interventions provided by the TSN resulted in more than 1500 stroke patients receiving the benefits of revascularization treatments, that are highly cost-effective. Our data provide a sound feedback that AIS care delivery can be improved through organization and logistics.