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Abstract
Introduction Revascularization therapies for acute ischemic stroke are strongly time sensitive. Outcomes with IV tPA administration are clearly improved with earlier treatment. With increasing evidence of efficacy of endovascular stroke treatment, the rapidity of treatment initiation will also likely be critical to improving patient outcomes. As endovascular stroke treatment is unavailable at most centers that may first evaluate acute stroke patients, the efficient triage and transfer of these patients will be increasingly important. We sought to assess the transfer times from regional stroke-ready hospitals to our comprehensive center as a measure of current efficiency.
Methods We evaluated the transfer times from six regional medical centers within a 120 mile radius to our comprehensive center. All transfers over the past year that were triaged as acute stroke with need for urgent transfer were included. Transfer time was defined as the interval between the initial call requesting transfer until arrival at our facility. These times were averaged for each referring hospital, and were compared to the driving time from our center to each site (using google maps). Any patient transfer that did not have precise arrival time was excluded from analysis. All data were derived from our hospital access center and patient records.
Results Transfer times from six different regional hospitals were included, ranging from 18 to 119 miles from our comprehensive center. There were 70 patient transfers from these hospitals over the past year for which transfer time was recorded. Overall average transfer time was 97.8 min. All transfer times were significantly longer than expected driving times, with average differences per hospital ranging from 46 to 133 min. In general the furthest regional hospitals had the lowest time difference from expected driving times, likely because air transport was used more frequently. However in no instance was hospital-to-hospital transfer quicker than expected driving time, even when air transport was used.
Conclusions The emergent transfer of stroke patients from regional medical centers to our comprehensive stroke center was extremely inefficient. The average time to transfer a patient was over an hour and a half, and some of the longest transfer times were from the nearest facilities. These findings suggest that increased efficiency in acute stroke care is needed, as clinical outcomes depend on rapid revascularization. Developing systems of care should focus on early stroke diagnosis and consideration of bypassing local hospitals to bring certain potential stroke patients directly to comprehensive centers.
Transfer time vs. drive time for stroke patient
Disclosures M. Froehler: None. K. Espaillat: None.