Abstract WP32: Thinking Outside The Box In Delivering Advanced Stroke Care In A Pandemic

Abstract

Background: The challenges presented by the COVID-19 Pandemic have caused healthcare providers, hospitals, and systems of care to re-think how care is provided to other acute time-sensitive diseases, such as stroke. Stroke admissions to hospitals decreased during the initial surge of COVID-19 cases. Purpose: To ensure Stroke patients who are eligible for endovascular therapy (EVT) receive timely access to evaluation and treatment when healthcare systems may be too overwhelmed with lack of post-procedural ICU beds and resources. Method: As a Primary Stroke Center (PSC), patients with stroke symptoms are quickly evaluated for potential treatment and advanced therapy. With Rapid software imaging, CTA and CT-P are readily available and reliable tools to diagnosis Large Vessel Occlusions (LVO). When eligible for EVT, patients are transferred emergently to a Comprehensive Stroke Center. With limited resources in the region, delays in care and transfers, ED and ICU beds were not readily available. Neuro-interventionalists were available to perform EVT but limited for lack of ICU bed availability. The CSC and PSC collaborated to develop a plan to transfer eligible patients for the EVT and transfer patient back to PSC ICU for post-procedure care. This allows the patient to receive appropriate and timely stroke care despite limited access to ICU beds at the CSC. Results: The CSC collaborated with the PSC to put this contingency plan into place. When an EVT eligible patient is identified at the PSC, the CSC is contacted for evaluation. If the patient is a candidate, the PCS admits patient to ICU and emergently transfers to CSC for outpatient procedure. This was approved by the billing department at both facilities. Conclusions: Modifications to stroke algorithms and care may be necessary during a Pandemic to maintain safe, efficient, and effective care. Communication and collaboration are key between stroke centers and stroke systems of care to facilitate positive outcomes without adding more challenges to an overwhelmed healthcare system