Evaluation of an out-of-catchment ambulance hyperacute FAST+ (stroke) bypass pathway

Abstract

Background
In March 2024, the Dublin Midland Hospital Group and National Ambulance Service introduced a Hyperacute FAST+ ambulance bypass protocol for patients who are normally in the catchment of two regional hospitals. This study aimed to describe the resource burden on the Tallaght University Hospital (TUH) emergency department (ED) and to quantify the patient journey times.

Methods
A single centre retrospective chart review was performed on all Hyperacute FAST+ patient presentations to TUH ED between March 2024 and February 2025. Journey times and distances were calculated using Google Maps.

Results
There were 62,728 attendances to TUH ED in the study period and of these 13,403 patients presented to TUH ED by ambulance. 162 (1.2%) of all ambulance attendances were patients presenting on the out of catchment Hyperacute FAST+ patients protocol. The mean age was 68 years. There were 93 males. The mean travel distance was 56.9km and the mean estimated travel time was 44.8 minutes. 91 patients (56.2%) were admitted to TUH. 16 (9.9%) patients conveyed on the pathway received thrombolysis and 9 (5.6%) received thrombectomy. The mean length of stay for admitted patients to TUH was 13.6 days.

Discussion
This Hyperacute FAST+ bypass protocol resulted in high admission rates and hospital length of stay in the regional stroke centre.