Abstract WP503: Your House or Mine: Where to Do Stroke Imaging for Thrombectomy Decision?

Abstract

Introduction: Thrombectomy is a standard of care for eligible patients, yet there are many systems of care challenges associated with where the advanced imaging is done. The goal is to always select the right patient for treatment, get them to the right center, in the right amount of time. Some experts suggest that EMS providers with a positively screened large vessel occlusion (LVO) patient by-pass Primary Stroke Centers (PSCs) to save time since performing advanced imaging at PSCs can add significant delay. But this by-pass can add travel time and the imaging might not support thrombectomy after all. Comprehensive Stroke Centers (CSCs) have the responsibility to provide guidance to PSCs, but when the hospitals are local competitors this can be a challenge. Methods: In 2017, the CSC and PSC Stroke Coordinators from competing hospitals collaborated on a CT Angiogram protocol to be implemented at the PSC. The protocol included expanding the stroke alert window to 24 hours. Results: At baseline, the PSC’s DIDO average was 2 hours and 8 minutes, 0% had a CTA prior to arrival to the CSC, and the average Door to Puncture (DTP) was 1 hour 27 minutes. Post-implementation of the CTA protocol, the PSC had a 28% reduction in Door-in Door-out (DIDO) time (average 1 hour 46 minutes) while the CSC noted a 41% decrease in the DTP time (average 51 minutes). 100% of transferring PSC cases had a CTA prior to CSC arrival. Conclusion: Collaboration between a CSC and PSC in standardization and visualization of a process facilitates awareness and supports rapid implementation in the emergency department. CTA completion at the PSC does not hinder DIDO times and contributes to appropriate patient selection, thus eliminating costly transport. The result is optimal, individualized stroke care that saves more than time... it saves brain.