Abstract P856: Contributors to Internal Primary Stroke Center Transfer Delays: Factors Beyond Stroke Coordinators’ Control

Abstract

Background: Stroke coordinators often are challenged to transfer patients to higher levels of care, facing internal system, transport, and comprehensive stroke center (CSC) factors that may slow the transfer process. We aimed to understand the internal challenges faced by stroke coordinators at primary stroke centers/acute stroke ready hospitals (PSC/ASRH) in the transfer process. Methods: Six national focus groups with PSC/ASRH staff experienced with stroke transfers were conducted by web conference. Interviews were conducted using pre-scripted open-ended questions; information was recorded and data were transcribed for theme identification. Results: Participants were from Northeast, Mid-Atlantic, Southeast, Midwest, and West Coast USA. Internal PSC/ASRH problems were tied exclusively to physicians: Emergency department (ED) physicians’ lack knowledge of how/when to order advanced imaging; delays initiating telemedicine guidance were common; and, negative attitudes towards stroke emergencies among “tenured” ED physicians were identified. All participants noted that they were compliant with door-to-noncontrast CT and alteplase treatment time metrics, however, radiologists commonly used the full 2-hours allotted for CTA and CTP reads, and many telemedicine neurologists refused to review/interpret advanced imaging choosing to rely on the local general radiologists’ formal interpretation. Conclusions: Major factors contributing to internal PSC/ASRH transfer delays are exclusively physician-based. Physician education, standardized algorithms for advanced imaging selection, more-timely regulatory metrics for advanced imaging interpretation, and improved telemedicine physician expertise and guidance would improve transfer timeliness in these centers.