Abstract WP50: Implementation Of The AHA/ASA Western States Quality Task Force Door In Door Out Best Practice Strategies Results In Quicker Transfer Times

Abstract

Background: Rapid Door in Door Out (DIDO) times at primary stroke centers (PSCs) continue to be a challenge. The AHA/ASA Western States Quality Task Force met between 2018-2020 to establish strategies that could be employed at most PSCs to decrease their DIDO times. We assessed the impact of these strategies on DIDO times in a health system with 13 PSCs. Methods: The committee met at regularly scheduled intervals and reviewed the available literature on DIDO to help establish the document. The key strategies include: 1)Target DIDO of ≤ 90 mins, 2) Rapid administration of IV thrombolysis (follow Target: Stroke key best practice strategies), 3) Rapid initiation of a transfer process with consideration of initiation based on examination, 4) Participate in a regional system of care, 5) Integration of telemedicine into the transfer process, 6) Rapid acquisition, interpretation and transmission of neuro imaging, 7) Expedited transport handoff, 8) Mock code strokes which include the external staff who are involved in the transfer process, 9) Prompt data collection, feedback and quality improvement. The key strategies were implemented in April 2021. We compared DIDO in the first three months pre-and post-implementation using the Student’s t-test. DIDO time intervals were also assessed. Results: Thirty-two patients were transferred in the pre-implementation phase vs. 29 in the post-implementation phase. There were no differences in median age (pre 65 vs. post 74), gender (pre 47% female vs. post 52% female), or median NIHSS (11 both pre and post). The DIDO decreased from 120 mins (IQR 95-152) to 79 mins (IQR 63-132) p=0.009. Patient arrival to transfer center call time non-significantly changed from a median of 55 mins (IQR 35-91) to 38 mins (IQR 29-79). Time from transfer center call time to outside hospital physician acceptance had a trend toward improvement from 17 mins (IQR 10-26 mins) to 13 mins (IQR 9-18) p=0.09. Ambulance arrival to ambulance departure non-significantly decreased from 24 mins (IQR 20-34) to 20 mins (IQR 16-25). Conclusion: Implementation of the AHA/ASA Western States Quality Task Force DIDO Best Practice Strategies can decrease overall DIDO times. These strategies can be easily employed at PSCs to improve patient outcomes.