Abstract TMP40: Standardized Interdisciplinary Team Handoff Communication Improves Thrombectomy Door-to-groin Time In Acute Ischemic Stroke Evaluated By Telestroke

Abstract

Introduction: Mechanical thrombectomy (MT) has a time-dependent effect on clinical outcomes in acute ischemic stroke (AIS) patients with large vessel occlusions (LVO). Most AIS patients who need MT evaluation present to a spoke Emergency Room (ER) and require transfer to a comprehensive stroke center (CSC) hub. Delayed or incomplete interdisciplinary team communication are potential barriers to timely MT. The purpose of this quality improvement (QI) project was to evaluate team members’ fidelity and acceptability to a new handoff protocol and effect on treatment times. Methods: Our academic CSC has a hub-spoke telestroke model that includes 27 spoke ERs in Ohio. An LVO handoff protocol was designed to ensure a structured process that required the telestroke physician to a) communicate to the receiving in-house stroke team and endovascular team; b) hand-off standardized data from transferring hospital including last known normal, National Institutes of Health Stroke Scale, and neuroimaging findings, and c) communicate a pre-arrival plan. Fidelity was measured by a standardized checklist and Acceptability was measured by Acceptability of Intervention Measure (AIM) questionnaire. Door-to-Groin (DTG) times 4 months pre- and 5 months post- implementation were reviewed. Results: Among 83 AIS patients (28 pre- and 55 post-implementation) transferred from a telestroke ER for suspected LVO, the mean age was 70.4 (± 13.7) and 32 (39%) were female. Overall fidelity was 81% with the lowest scores noted on weekends. Acceptability among team members was 96%. Overall DTG mean time was 64.0 minutes (+/- SD 51) for the entire period. The mean DTG improved from pre-protocol to post-protocol period by 29.2 minutes (83.4 vs. 54.2 min, p = 0.0136). Conclusions: Standardized pre-arrival interdisciplinary team communication for AIS LVO patients transferred to CSC in a telestroke hub-stroke model was feasible and associated with improvement in DTG times. Further studied needed for sustainability and ongoing improvement.