Total Transfer Time for Ground vs. Air Transport for Interhospital and Scene Transfers of Acute Stroke Patients

Kunte, Sameer; Anderson, Drew; Brown-Espaillat, Kiersten; Froehler, Michael T.

doi:10.1016/j.jstrokecerebrovasdis.2021.105704

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…In our secondary analysis, we found that the selection of transfer mode could be further improved according to the distance between the primary hospital and CSC, i.e., for distances <51 km, ambulance and for >70 km, helicopter transfer. Our finding is in line with a previous study and highlights that the efficiency of transfer of stroke patients depends on the logistics prior to emergency medical service arrival as well as the speed of travel [ 19 ]. It is worth noting that for distances <51 km, 91.4% of patients were transported by ambulance, for 51–70 km, 36%, and >70 km, 24.5%.…”

Section: Discussionsupporting

confidence: 93%

Optimizing Time Management for Drip-and-Ship Stroke Patients Qualifying for Endovascular Therapy—A Single-Network Study

et al. 2022

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BACKGROUND: We sought to identify factors for delayed drip-and-ship (DS) management in stroke patients transferred from primary hospitals to our comprehensive stroke center (CSC) for endovascular therapy (EVT). METHODS: We conducted a retrospective study of all patients transferred to our CSC for EVT between 2016 and 2020. We analyzed emergency and hospital records to assess DS process times and factors predictive of delays. We dichotomized the admission period to 2016–2017 and 2018–2020 according to the main process optimization, including the introduction of a prenotification call. RESULTS: We included 869 DS patients (median age 76 years (IQR 65–82), NIHSS 16 (IQR 11–21), 278 min (IQR 243–335) from onset to EVT); 566 were transferred in 2018–2020. Admission in 2016–2017, during on-call, longer tranfer distance, and general anesthesia were factors independently associated with delayed onset to EVT time (F(5, 352) = 14.76, p < 0.000). Other factors associated with delayed DS management were: transfer mode, primary hospital type, site of large-vessel occlusion, and intravenous thrombolysis. Total transfer time was faster for distances <50 km by ambulance and for distances >71 km by helicopter. CONCLUSION: Assessment of DS processes and times throughout the patient pathway allows identification of potentially modifiable factors for improvement of the very time-critical workflow for stroke patients.

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Section: Discussionsupporting

confidence: 93%

Optimizing Time Management for Drip-and-Ship Stroke Patients Qualifying for Endovascular Therapy—A Single-Network Study

et al. 2022

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“…The Netherlands also has an overall good road and highway infrastructure, which makes even remote hospitals relatively easy to reach. In a recent cohort study of patients transferred for EVT in the USA (31), average time between first call to the dispatch center and arrival of EMS at the patient's location when traveling over ground was 16 min, compared to 7 min in our study. Average travel distance between PSC and CSC was 47 miles, resulting in a transfer time of 50 min, while in our study the median travel distance was 54 kilometers (33 miles), with a median transfer time of 28 min.…”

Section: Discussioncontrasting

confidence: 60%

Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy

et al. 2021

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Background: Patients with large vessel occlusion (LVO) stroke are often initially admitted to a primary stroke center (PSC) and subsequently transferred to a comprehensive stroke center (CSC) for endovascular thrombectomy (EVT). This interhospital transfer delays initiation of EVT. To identify potential workflow improvements, we analyzed pre- and interhospital time metrics for patients with LVO stroke who were transferred from a PSC for EVT.Methods: We used data from the regional emergency medical services and our EVT registry. We included patients with LVO stroke who were transferred from three nearby PSCs for EVT (2014–2021). The time interval between first alarm and arrival at the CSC (call-to-CSC time) and other time metrics were calculated. We analyzed associations between various clinical and workflow-related factors and call-to-CSC time, using multivariable linear regression.Results: We included 198 patients with LVO stroke. Mean age was 70 years (±14.9), median baseline NIHSS was 14 (IQR: 9–18), 136/198 (69%) were treated with intravenous thrombolysis, and 135/198 (68%) underwent EVT. Median call-to-CSC time was 162 min (IQR: 137–190). In 133/155 (86%) cases, the ambulance for transfer to the CSC was dispatched with the highest level of urgency. This was associated with shorter call-to-CSC time (adjusted β [95% CI]: −27.6 min [−51.2 to −3.9]). No clinical characteristics were associated with call-to-CSC time.Conclusion: In patients transferred from a PSC for EVT, median call-to-CSC time was over 2.5 h. The highest level of urgency for dispatch of ambulances for EVT transfers should be used, as this clearly decreases time to treatment.

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“…[21][22][23] Air medical transport can have adverse events relating to communication errors and equipment failures occurring as high as 30%. 18 As previously reported, transfer efficacy depends on logistics before emergency medical services arrival and the speed of travel 24 ; therefore, not only the availability of HEMS but also a high-standard strategy for operative logistics need to be carried out. Challenges that the staff has to surpass include a lack of recognition of the importance of logistics, a lack of professional staff, inadequate use of technology, a lack of institutional learning, and limited collaboration.…”

Section: Discussionmentioning

confidence: 98%

Effect of Helicopter Transportation of Acute Ischemic Stroke Patients on Mortality and Functional Outcomes: A Systematic Review and Meta-Analysis

Florez-Perdomo¹,

García-Ballestas

Konar

et al. 2022

Air Medical Journal

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Total Transfer Time for Ground vs. Air Transport for Interhospital and Scene Transfers of Acute Stroke Patients

Cited by 11 publications

References 22 publications

Optimizing Time Management for Drip-and-Ship Stroke Patients Qualifying for Endovascular Therapy—A Single-Network Study

Optimizing Time Management for Drip-and-Ship Stroke Patients Qualifying for Endovascular Therapy—A Single-Network Study

Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy

Effect of Helicopter Transportation of Acute Ischemic Stroke Patients on Mortality and Functional Outcomes: A Systematic Review and Meta-Analysis

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