THE MELBOURNE MOBILE STROKE UNIT: INTITAL OPERATIONAL CHALLENGES

Skye Coote1,2, Henry Zhao1,2, Lauren Pesavento1, Brett Jones1, Francesca Langenberg3, Patricia Desmond2,3, Damien Easton1,2, Lindsay Bent4, Shane Foster4, Michael Stephenson4, Karen Smith4, Stephen Bernard4, Christopher Bladin5, Dominique Cadilhac5, Bernard Yan1,2, Bruce Campbell1,2, Mark Parsons1,2, Geoffrey Donnan1,2,5, Stephen Davis1,2 for the Melbourne MSU writing group

1The Melbourne Brain Centre and Department of Neurology, Royal Melbourne Hospital
2Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne
3Department of Radiology, Royal Melbourne Hospital
4Ambulance Victoria
5The Florey Institute of Neuroscience and Mental Health

Background:
The Melbourne Mobile Stroke Unit (MSU) is the first of its kind in Australia. It launched on 20/November/2017. Despite a burgeoning global knowledge regarding MSU functionality, each MSU is unique in purpose and footprint. All of the current international MSUs have distinctive barriers and enablers that require objective review in order to facilitate optimisation of second and third generation MSU programs.

Methods:
To describe the unique challenges faced by the Melbourne MSU during the development and initial activity phases.

Results:
The Melbourne MSU operates Monday-Friday 8am-6pm. Responsibility for daily operations is held jointly by The Royal Melbourne Hospital and Ambulance Victoria. Initial operational challenges encountered during set-up included: adapting hospital stroke protocols for use in the pre-hospital setting; accountability and storage considerations for hospital-provided medications versus ambulance medications; workflow processes across 3 distinct on-board craft groups (neurology, radiology, paramedics) and communication with 8 independent MSU-receiving stroke centres. Since launching, communication remains a challenge, both within hospitals and across Ambulance Victoria, with some staff remaining unaware of the service. Enablers to this project have included significant buy-in of major stakeholders, strong operational collaborations of technical experts, community and philanthropic support, and global collaboration with international MSUs.

Conclusion:
The Melbourne MSU is in operational infancy. As with any new clinical service, new barriers continue to arise. Barriers have been resolved primarily by strong operational monitoring by the major partner organisations, community support, international collaboration and a core team of cross-trained experts with the shared mission of improving Australian stroke care.

THE MELBOURNE MOBILE STROKE UNIT: INITAL OPERATIONAL CHALLENGES