Abstract WMP48: The Brain Emergency Management Initiative: Reduction of Embolectomy Transfer Times Using a Novel Telestroke Transfer Protocol

Abstract

Recent studies of national door-in-door-out times (DIDO) in the Get with the Guidelines Stroke registry found that <30% of transfers for acute interventions were completed within the recommended 120 minute timeframe. There is a critical need for effective emergent transfer protocols to improve outcomes. The Brain Emergency Management Initiative (BEMI) is a telestroke transfer protocol connecting acute stroke patients at hub sites to a spoke center for embolectomy. BEMI includes early activation of helicopter transport, rapid imaging transmission, standardized documentation, and remote patient admission. BEMI has been shown to significantly reduce DIDO and time-of-treatment-decision-to-groin-puncture (TDGP). The aim of this study was to evaluate the sustainability of the BEMI impact on reduction of key transfer metrics. We retrospectively assessed prospectively collected data for patients transferred for embolectomy in our telestroke system. Patients were assessed in 3 groups: pre-BEMI (2013-mid 2016; before protocol, n=32), early-BEMI (mid 2016-2017; initial year of protocol, n=31) and new-BEMI (2018-2023; n=210). Inclusion criteria were emergency telestroke consultation and transfer for acute embolectomy. Exclusion criteria were inpatient telestroke consultation, incomplete data and aborted transfers. Variables were assessed via Chi-square, T-test or Wilcoxon Rank Sum as appropriate. Median times were used given skewedness of data. We evaluated 273 total transfers. Analyses compared BEMI groups to the pre-BEMI group. Median NIHSS was higher in the BEMI groups (pre-BEMI median=10 points vs. early-BEMI=20, p=0.0063 ; vs. new-BEMI=17, p=0.005 ). There were significantly shorter median DIDO and TDGP times in the BEMI groups (DIDO: pre-BEMI median=143 minutes vs. early-BEMI=118, p=0.015 ; vs. new-BEMI=97, p=1.7e-7 ) (TDGP pre-BEMI median=155 minutes vs. early-BEMI=130, p=0.01 ; vs. new-BEMI=125, p=6.8e-14 ). This finding was sustainable from the early to new BEMI groups. Additional time metrics will be assessed in this dataset. The BEMI protocol significantly improved transfer and treatment times in our telestroke network. BEMI may serve as a model for stroke transfer protocols at other centers to assist in improving time metrics.