Kathleen L. Bagot - Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia
Tara Purvis - Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
Shaun Hancock - Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia
Henry Zhao - Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
Skye Coote - Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
Damien Easton - Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
Bruce CV Campbell - Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
Stephen M. Davis - Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
Geoff A. Donnan - Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia
Shane Foster - Ambulance Victoria, Melbourne, VIC, Australia
Francesca Langenberg - Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
Karen Smith - Ambulance Victoria, Melbourne, VIC, Australia
Michael Stephenson - Ambulance Victoria, Melbourne, VIC, Australia
Stephen Bernard - Ambulance Victoria, Melbourne, VIC, Australia
Sharon McGowan - Stroke Foundation, Melbourne, VIC, Australia
Bernard Yan - Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
Peter Mitchell - Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
Sandy Middleton - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
Dominique A. Cadilhac - Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia

Background  Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care.Methods  Mixed-methods study from the Melbourne MSU (operational since November ۲۰۱۷) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September ۲۰۱۹). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted.Results  There were ۱۳۵ surveys completed. Identifying that the MSU was beneficial to daily work (β = ۰.۶۱), not experiencing pressure/tension about working on the MSU (β = ۰.۱۷) and thinking they did well working within the team model (β = ۰.۱۷) were significantly associated with wanting to continue working within the MSU model [R۲ = ۰.۷۶; F(۱۵, ۶۰) = ۱۲.۷۶, P < .۰۰۱]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from ۳۵ interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity.Conclusion  Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability.

Stroke, Ambulances, Evaluation Studies, Program Sustainability