Abstract TMP18: Real-World Challenges in US Thrombectomy Transfers: Difficulty Finding an Accepting Hospital, Prolonged Travel, and Differing Perceptions of Transfer Requirements

Abstract

Introduction: Transfers can improve access to endovascular thrombectomy (ET). However, benefit is highly time-dependent and transferred patients experience poorer outcomes. We assessed perceptions of transfers processes between sending and receiving hospitals. Methods: We utilized an ongoing 2023 nationwide US electronic survey of hospitals that treat stroke patients with revascularization therapy and have publicly available contact information. Respondents were stroke directors or coordinators. Survey items analyzed included questions on certification status, transfer processes, volumes, times, delays, and requirements for transfers. We performed cross-sectional analyses of hospitals that send/receive ET transfers. We used descriptive statistics and chi-squared tests to compare sending and receiving cohorts. Results: Of 144 responding hospitals at the time of analysis, 70.1% (n=101) receive and 29.9% (n=43) send ET transfers. Most (76.2%) receiving hospitals are comprehensive stroke centers and most (95.3%) sending hospitals primary stroke centers (p<0.05). Only 39.5% of sending hospitals send ≥20 transfers annually vs. 64.4% of receiving hospitals that receive ≥20. More than 1/2 send/receive transfers to/from facilities >60 miles away, and 50% pass a closer capable hospital en route. Average door-in-door out time is >90 minutes for 51.2% of sending hospitals, and 35.0% spend >50% of this time on non-care coordination. Concerningly, 34.9% of sending hospitals are sometimes/always unable to find an accepting hospital. Perceptions of requirements for transfer vary between receiving and sending hospitals: 30.7% vs. 76.7% require large vessel occlusion confirmation, 1% vs. 14% perfusion imaging and 14.9% vs. 32.6% an available bed prior to transfer (p<0.05). Conclusion: In this real-world sample, transfers are common, perceptions of requirements for transfer differ, and there are actionable delays. Concerningly, sending hospitals are often unable to find an accepting hospital and closer hospitals are frequently passed en route. Future interventions could standardize and provide oversight of regional stroke systems of care.