Abstract TMP63: Door-In-Door-Out Process Times at 5 Primary Stroke Centers in Chicago

Abstract

Introduction: Many patients with acute stroke require inter-facility transfer from primary stroke centers (PSC) to comprehensive stroke centers. Given the time-sensitive benefits of endovascular treatments, door-in-door-out (DIDO) time at the PSC is a target for quality improvement. Methods: As part of a funded ongoing study of redesigning the acute stroke DIDO process, we collected data on consecutive patients with acute stroke between February 2018 and February 2019 who required inter-facility transfer from 5 PSCs to one of 3 CSCs in the Chicago region. The stroke coordinators at each site abstracted data on mode of transport (critical care vs. advanced life support [ALS]), medical events and treatments (intubation, intravenous medications including tPA), times from arrival to: triage, telestroke activation and start, CT and CTA start, initial transfer center contact, ambulance request, and ambulance arrival and departure times. We evaluated predictors of DIDO time using linear regression. Results: Among 107 patients who met study criteria, 67.6% arrived by EMS, 83.2% had telestroke evaluation, 34.6% had tPA treatment, and 43.9% underwent CTA at the PSC. The median DIDO time was 146 (IQR 99-220) minutes. The largest contributors to DIDO time (Figure) were CT to CTA time (45 [18-86] minutes), ambulance scene time (26 [21-35] minutes), and telestroke to transfer center contact (median 23 [0-61] minutes). Independent predictors of DIDO time were obtaining CTA (+64.1 [29.4-98.5] minutes), use of ALS ambulance (+52.5 minutes [17.5-87.5] minutes), and use of intravenous medications besides tPA (+59.9 [15.7-104.1] minutes). Conclusions: We identified major opportunities for reducing DIDO times for inter-facility acute stroke transfers. Reducing the need for or time to CTA, earlier, streamlined transfer center contact, and using critical care ambulances are likely important strategies to decrease DIDO times.