Abstract P155: The Network Effect on Inter-Facility Transfers Among Regional Stroke Certified Hospitals

Abstract

Introduction and Purpose: Timely inter-facility transfer of thrombectomy-eligible patients is a mainstay of Stroke Systems of Care. We investigated transfer patterns among stroke certified hospitals in the Dallas-Fort Worth Metroplex (19 counties, 9,286 sq mi, >7.7 million people), by hospital network and stroke center status. Methods: In Feb 2020, all 44 North Central Texas Trauma Regional Advisory Council (NCTTRAC) hospitals identified network status, stroke designation and geographic location. Stroke Assessment and Large Vessel Occlusion (LVO) screening tool use was evaluated. The distance between the sending and receiving facility was calculated using GPS coordinates. If the closest Comprehensive Stroke Center (CSC) was not used, the average distance between the selected and the closest CSC was geospatially mapped via R statistical analysis software (Vienna, Austria) gmapsdistance package. Results: Of the 44 facilities, 6 were Acute Stroke Ready Hospitals (ASRHs), 27 were Primary Stroke Centers (PSCs), 11 were CSCs (Fig 1). Seventy-seven percent (n=34) were part of four hospital networks. All facilities used stroke assessment tools; 57% completed LVO screening. Seventeen percent of ASRHs (n=1) and 56% of PSCs (n=15) conducted inter-facility transfers. Sixty percent of non-network facilities transferred to the closest CSC. Of the remaining 40%, the average distance between the closest and the selected CSC was 1.5 miles (min max 0.2-2.9). Seventeen percent of network facilities transferred to the closest CSC. Among the remaining 83%, the average distance between the closest and the selected CSC was 4.1 miles (min-max 1-8). Conclusions: Non-network facility status increased the likelihood of transfer to the closest Comprehensive Stroke Center. Transfer distance variability among network facilities may contribute to delays in reperfusion therapy. Figure 1 . Transfer Patterns (in Blue) of Dallas Fort-Worth Metroplex Hospitals by Stroke Center Designation