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O-010 Door to revascularization in less than 60 minutes: a cost and benefit analysis
  1. D Frei1,
  2. B Atchie2,
  3. I Kaminsky2,
  4. R Bellon2,
  5. D Wilson2
  1. 1Neurointerventional Surgery, Radiology Imaging Associates, Denver, CO
  2. 2Neurointerventional Surgery, Radiology Imaging Associates, Englewood, CO


Background In order to maximize clinical outcomes in patients with acute ischemic stroke related to ELVO (Emergent Large Vessel Occlusion), safe and rapid recanalization is necessary. Our level 1 stroke center has developed a standardized protocol which has allowed us to achieve a median door-to-recanalization time of less than 60 min. In order to achieve such rapid recanalization rates, the neuro-interventional team is called in to meet the stroke patient upon their arrival to the hospital. We will describe our protocol for achieving rapid recanalization, and we will discuss the cost.

Methods For the last 18 months, while treating more than 300 patients, we have achieved a median door-to-recanalization time of <60 min. Standardizing a protocol for rapid clinical and imaging assessment for rapid transport to the angiography suit has contributed to this rapid time metric, as has a standardized thrombectomy procedure, but the most important contribution to time savings was calling in the neuro-interventional team to meet the patient upon their arrival to the emergency room. The neuro-interventional team called in to meet the patient includes: 1 RN, 2 technologists, 1 anesthesiologist and 1 neurointerventional surgeon. We will analyze time metrics, the percent of neuro-interventional stroke alerts that proceed to thrombectomy and the personnel costs for this protocol in this consecutive cohort of patients.

Results From 1/1/2017 – 3/31/2018, there were 1162 ELVO activations of the neuro-interventional team. Of these alerts, 314 proceeded to thrombectomy, equal to a 27% rate of thrombectomy. This rate was 21% during weekday working hours, 43% after 5 PM on weekedays, and 29% on weekends. If a thrombectomy is not performed, the RN and technologists are each paid 2 hours of overtime pay. Not counting hours lost in daytime productivity, physician time, and hours of lost sleep, there were more than 5000 hours paid to the RNs and technologists for these alerts that did not proceed to thrombectomy, totaling > $200,000.00 in overtime pay. The median time from patient arrival to recanalization was 52 min. The median time from door to groin puncture was 34.5 min, and from groin puncture to recanalization was 17.5 min.

Conclusion Rapid and safe revascularization helps achieve the best clinical outcomes in ELVO patients, and our stroke systems of care need to be streamlined to achieve these rapid time metrics, but it comes at a cost. Cost benefit analysis suggests in house neurointerventional teams may be needed to take care of these patients best.

Disclosures D. Frei: 1; C; Ceranovus, Stryker, Medtronic, Siemens, Microvention, Penumbra. 2; C; Ceranovus, Stryker, Penumbra, Genentech. 3; C; Ceranovus, Stryker, Penumbra, Genentech. 4; C; Penumbra. B. Atchie: None. I. Kaminsky: None. R. Bellon: None. D. Wilson: None.

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