Abstract 2319: Improving Inter-facility Transfer Times for Acute Ischemic Stroke Patients: The Stroke Rescue Program

Abstract

Background and Purpose: The inter-facility transfer of acute ischemic stroke (AIS) patients to a comprehensive stroke center (CSC) must be rapid. Transfer delays increase the likelihood of exclusion from endovascular stroke therapy and therefore are an obstacle to time sensitive stroke treatments. Reducing transport times and improving transfer efficiency is integral to the success of a comprehensive stroke network. Methods: The Stroke Rescue Program was created within a large metropolitan health system to facilitate the rapid transfer of AIS patients from regional (both health system (n=8) and non-system (n=4)) primary stroke centers (PSC) to the network's CSC. Program interventions included creation of a transfer center and stroke rescue hotline with a new priority dispatching protocol; standing order medical treatment guidelines with paramedic, referring physician and staff education; and the development of transport time elements and targets. Selected time elements included Transport 1 (Tr-1, initial phone call to EMS arrival at PSC), ED Time (PSC arrival to PSC departure), and Transport 2 (Tr-2, PSC departure to CSC arrival). Total transport time target was set at <60 min and to achieve this we aimed at decreasing ED Time. Results: Between January 1, 2010 and June 30, 2011, 128 patients underwent Stroke Rescue. The median PSC to CSC distance was 14.4 miles (range 3.0 to 32.1 miles). Ischemic stroke was confirmed in 116 (91%) patients and 65 (51%) patients were “drip and ship” transports (intravenous tPA infusion during Tr-2). Overall, median total transport time was 48 min (ED Time 18 min). Comparing first quarter 2010 (baseline quarter, n=21) to second quarter 2011 (most recent quarter, n=31), the percent transported within 60 min increased from 57% to 81%. Statistically significant improvement was seen for both median ED Time (23 min versus 14 min; U = 171, p <.01, r = .40) and median total transport time (56 min versus 44 min; U = 199, p <.05, r = .33). Conclusion: Process organization with inter-facility stroke transfer protocols that minimize the time paramedics spend in a PSC emergency department can significantly reduce transport duration making transfer for time limited stroke therapies practical. Further study is needed to determine whether improved stroke network efficiency translates into better clinical outcomes, but the concept of “time is brain” supports this approach.