Abstract NS2: An Expedited Transfer Process Improves Door In Door Out Times

Abstract

Background: Rapid reperfusion with mechanical thrombectomy for ischemic stroke secondary to large vessel occlusion leads to significant reduction in morbidity and mortality. DIDO time is an important metric for stroke centers without on-site mechanical thrombectomy. Delays in treatment can occur when patients present at a Primary Stroke Center (PSC) then require transfer to the CSC for MT. Our system Comprehensive Stroke Center (CSC) receives patients from 2 of our system’s PSCs. In order to expedite care an expedited transfer protocol was implemented. Purpose: The goal of this work is to decrease the time at the PSC, known as door-in-door-out (DIDO), and decrease overall time from patient presentation to treatment with thrombectomy. Methods: Patients are screened at triage by a PSC emergency department provider for the following: aphasia, gaze preference, or neglect with unilateral weakness within 24 hours of last known normal. If these criteria are present, the emergency department provider contacts the CSC transfer center to initiate the expedited transfer process, which begins mobilizing resources to the PSC while clinical work-up continues. This expedited early transfer process was implemented in January 2021. Transfers for MT during the 12-month period before and after the implementation of the expedited transfer process were analyzed. Results: A sustained reduction in overall DIDO was observed during the time period following implementation of the expedited transfer process (Fig 1) Mean DIDO was lower when the transfer call was placed before CT vs after CT (81 min vs. 132 min respectively) (p=.0031). Conclusions: Use of the Expedited Transfer Process allows transfer resources to begin moving to the patient with a suspected LVO in parallel with ongoing evaluation, resulting in faster DIDO times leading to faster treatment aimed at reducing stroke morbidity and mortality. Further analysis of the effect of the expedited transfer process on DIDO times is planned.