Abstract TP281: Dual Notification and Early Transfer of Acute Stroke Patients: A Pilot Study

Abstract

Introduction: Significant disparities in clinical care exist for acute stroke patients in geographic areas without direct access to a Comprehensive Stroke Center (CSC). Stroke patients treated with IV tPA are often transferred to CSCs for endovascular therapy. These transfer patients have longer delays to intervention and are less likely to be treated compared to patients who present to CSCs. This pilot study assessed the feasibility and effectiveness of a novel notification and transfer process in a regional system of stroke care. Methods: The pilot was carried out at Stanford University Hospital, a CSC, and Community Hospital of Monterey Peninsula (CHOMP), a Primary Stroke Center (PSC) which regularly transfers complex stroke patients to Stanford. The process interventions included dual notification of PSC and CSC at the time of stroke patient arrival to the ER, earlier communication between the PSC ER physician and the CSC stroke team, rapid imaging interpretation by CSC stroke physicians, and streamlined transport between centers. Outcome measures including treatment rates and times were compared to the two prior years. Results: The pilot spanned 105 days and included 134 stroke calls and 43 ischemic stroke patients. A higher proportion of ischemic stroke patients were transferred during the pilot (10/43 (23%) vs. 14/122 (11%) in the prior year and vs. 11/96 (11%) 2 years prior, p<0.001). Transfer time did not differ (231 min vs. 253 min, pilot vs. 1 year prior, p=0.33), but when the process was assessed using statistical process control methodology the control chart showed a significant reduction in process variability. All transfers were determined to be appropriate for higher level of care (i.e. requiring hemicraniectomy or neuroICU monitoring), an improvement from the prior year when 2 patients were retrospectively determined to have been unnecessary transfers. Conclusions: An early communication-based intervention to better connect PSCs with CSCs is feasible and increased transfer rates for appropriate patients, with trends toward shorter transfer times. A similar system may be a viable option for hospitals without telemedicine or adequate neurology coverage. The next step is implementation of an iterated version across a larger health system.