Abstract TP37: Ten-Year Single Center Experience of Intra-Hospital Triage for Endovascular Treatment: The Hardest Hurdle During Late Off-Duty Hours

Abstract

Background and Purpose: Intra-hospital time delays can affect the outcome following endovascular treatment (EVT). To overcome these hurdles, multidisciplinary quality improvement (QI) program could be helpful in that it can improve intra-hospital time-related factors with subsequent better clinical outcome. We aimed to describe our ten-year experience of endovascular triage via the multidisciplinary QI program with emphasis on time-related factors. Methods: Based on our prospectively maintained EVT registry (n=602), three consecutive periods were defined based on the implementation of QI program and the changes in the primary modality of first angiographic imaging: (1) period 1 (May 2006 to December 2009); (2) period 2 (January 2010 to August 2012); and (3) period 3 (September 2012 to April 2016). Definitions of working hours: On-duty was defined as regular working hour from AM 8:00 to PM 6:00, and off-duty was defined as night shift from PM 6:00 to AM 8:00 the following day. Off-duty was classified into two groups by early off-duty as PM 6:00 to midnight and late off-duty as midnight to AM 08:00 the next day. Also, regular working hours in holidays were considered same as early off-duty. Results: Overall, successful reperfusion (mTICI 2b-3, post-procedure) and favorable outcome (mRS 0-2 or equal to pre-stroke mRS, at 3-month) was achieved in 395 patients (65.6%) and 311 patients (51.6%), respectively. A trend for increase in successful reperfusion and favorable outcome over periods was observed ( p<0.001 , respectively). Also, significant trends for shorter door-to-picture and door-to-puncture (DtoP) times over periods were observed ( p<0.001 , respectively). Inside each period, late off-duty hours were the hardest time period for improvement. In period 3, the DtoP time was 98.0 (IQR 79.0 - 118.0) minutes in late off-duty hours compared to 77.0 (IQR 60.5 - 88.5) minutes in on-duty hours ( p<0.001 ). Conclusions: Upward trend in successful reperfusion and better outcome were observed along with improvement in intra-hospital workflow to decrease door-to-puncture time, which emphasizes the importance of incessant QI program of EVT workflow. However, late-off duty hours were the hardest time point for improvement.