Transferring Patients From a Primary Stroke Center to Higher Levels of Care: A Qualitative Study of Stroke Coordinators’ Experiences

Abstract

BACKGROUND Transfer times from primary stroke centers and acute stroke–ready hospitals to higher levels of care are often excessive, prompting some to suggest ambulance bypass regulations. Since barriers to rapid transfer have never been fully explored, we sought to understand stroke coordinators’ experiences with transfer of patients with hyperacute stroke from lower to higher levels of stroke centers. METHODS We conducted a national focus group study with primary stroke center stroke coordinators who had recent experience overseeing transfer of a patient with hyperacute stroke to a higher‐level stroke center. Interviews were conducted using prescripted open‐ended questions; information was recorded and data were transcribed for theme identification. RESULTS A total of 23 stroke coordinators participated representing the Northeast, Mid‐Atlantic, Southeast, Midwest, and Western United States. Findings were grouped into 3 main categories: Internal Primary Stroke Center Factors, Transport Factors, and External Comprehensive Stroke Center Factors. Within the primary stroke center group, themes slowing transfer were exclusively physician based, whereas themes emerging from the transport category were associated with poor transport company processes. Within the comprehensive stroke center category, themes were all associated with complex hospital processes and communication. CONCLUSION Important contributors to efficient transfer of patients with hyperacute stroke are beyond the control of stroke coordinators, requiring cross‐system collaboration and improved administrative management to resolve. Quantification of these factors is warranted to support transfer system redesign for rapid access to care for patients with stroke.

The Impact of Artificial Intelligence on Large Vessel Occlusion Stroke Detection and Management: A Systematic Review Meta-analysis

“…Delays may occur due to logistical challenges, including traffic congestion or adverse weather conditions, time of day, and visibility (Glober, 2023). 3) Interfacility communication: Effective communication between the primary and comprehensive stroke centers is crucial for seamless transfer and continuity of care (Patterson, 2023). Delays may arise from communication barriers or breakdowns in information exchange between healthcare providers (Patterson, 2023).…”

“…3) Interfacility communication: Effective communication between the primary and comprehensive stroke centers is crucial for seamless transfer and continuity of care (Patterson, 2023). Delays may arise from communication barriers or breakdowns in information exchange between healthcare providers (Patterson, 2023). 4) Bed availability: Limited beds or resources at the comprehensive stroke center may lead to delays in accepting transferred patients.…”

“…Delays may occur if transfer protocols are not followed or if there are discrepancies in protocols between facilities (Kodankandath, 2017). 6) Specialist availability: Timely access to stroke specialists, neurologists, and other healthcare professionals is critical for prompt evaluation and treatment at the comprehensive stroke center (Patterson, 2023). Delays may arise if specialist expertise is unavailable or there are consultation delays (Patterson, 2023).…”

“…6) Specialist availability: Timely access to stroke specialists, neurologists, and other healthcare professionals is critical for prompt evaluation and treatment at the comprehensive stroke center (Patterson, 2023). Delays may arise if specialist expertise is unavailable or there are consultation delays (Patterson, 2023). This issue can be effectively addressed through dedicated telestroke services.…”

Ideal Foundational Requirements for Stroke Program Development and Growth: A Scientific Statement From the American Heart Association

“…24,42 All telestroke responders must be both capable and willing to independently interpret neuroimaging instead of relying on local or remote radiologist interpretation; this ensures rapid diagnosis, treatment, and recognition of the need for emergency transfer. 43 Telestroke oversight on off shifts does not define CSC-level services; instead, CSC hospitals may provide telestroke services for networked or affiliated facilities.…”