Abstract TP46: Improving Efficiency of Interfacility Transfer for Mechanical Thrombectomy: Delaware Stroke System Experience

Abstract

Introduction: Delaware (DE) created a stroke system with a primary objective to improve the interfacility transfer process between DE PSCs and its only CSC to improve efficiency and outcomes for mechanical thrombectomy (MT) transfer patients. Methods: The DE stroke system, including stroke coordinators/medical directors and EMS, defined criteria for MT eligibility, identified barriers to transfer, and implemented the interventions listed below. Data on transfer volumes, thrombectomy rates, and outcomes were collected. Objectives were to improve early detection of MT eligible patients, improve rate of thrombectomy on MT transfers, and track patient outcomes (mRS 0-2 at 90 days). • MT eligibility defined as any patient with a significant/disabling deficit with target lesion identified on CTA. • Implementation of “EZ” button in PSC EDs for early activation of flight team for suspected MT candidates upon initial clinical evaluation. • Time goal of 30 min for PSC arrival to call out to CSC for MT candidates. • Implementation of RAPID.AI platform at PSCs to allow CSC immediate access to imaging. • Revision of CSC transfer process: conference call with transfer center, PSC physician, and CSC stroke team physicians to discuss case. • Transport expedited for MT eligible patients; ineligible patients stay at PSC. • CSC provides outcome feedback and time goals to PSC on each transfer. • Variant cases reviewed by CSC and DE Stroke System Quality & Data committee as needed. Results: From FY22 to FY23, there was a 39% increase in MT transfers, 20% increase from 52% to 72% in rate of thrombectomy, and 15% increase in # patients in mRS 0-2 category at 90d (figure 1). Conclusion: By implementing collaborative and focused interventions, the DE stroke system increased rates of MT in transferred patients while reducing unnecessary transfers and improving patient outcomes.