Abstract 2682: Tracking Inter-hospital Transfer Process to Reduce Time from Initial Presentation to Neurovascular Intervention in Acute Stroke

Evaluating Inter-hospital Transfer Process to Reduce Time from Initial Presentation to Neurovascular Intervention in Acute Stroke Background As neurovascular intervention becomes a viable option for large vessel ischemic stroke, establishing a process for rapid transfer from Primary Stroke Center (PSC) to Comprehensive Stroke Center (CSC) is imperative to providing timely intervention. Purpose To establish a process for defining key data elements and quality measures for improving inter-hospital transfer time for acute stroke patients in need of neurovascular intervention. Methods Nursing coordinators in a rapidly growing multi-hospital acute stroke referral network in North and Central Georgia provide feedback on the patient transfer process and key indicators that can accelerate treatment times. Data from inter-hospital transfers are reviewed. Concurrent and retrospective chart reviews from the PSC and the CSC are utilized for data abstraction. Team members include vascular neurologists, Emergency Department (ED) physicians, referring neurologists, ED and Intensive Care Unit nursing staff, Stroke Coordinators, and Emergency Medical Services. Results Time sensitive data elements include arrival at PSC (PSC-Arr), departure from PSC (PSC-Dep), arrival at CSC (CSC-Arr), and groin puncture for angiogram. Key process measures include calculated times for the following: a) PSC-Arr to MD discussion regarding transfer, b) PSC-Arr to PSC-Dep, c) PSC-Arr to CSC-Arr), d) CSC-Arr to intervention, e) PSC-Arr to intervention. Process improvement focuses on improving PSC ability to rapidly do the following: identify patients, initiate physician communication between PSC and CSC, initiate and complete transfer process, notify EMS transport, and providing a process for rapid registration at the CSC. Other key improvements that enhance the transfer process include real time image sharing between PSC and CSC, EMS education, and clinical feedback from CSC to PSC. Conclusion Evaluation of data elements in the transfer process identifies opportunities to reduce transfer time between Primary Stroke Centers and Comprehensive Stroke Centers. In a multihospital referral network, process improvement in acute stroke should focus on the timely and efficient transfer of patients from a PSC to a CSC. By analyzing the key components of the transfer process, we identified opportunities to decrease time to neurovascular intervention in acute ischemic stroke. With the exponential growth of the vascular neurology field and interventional options, tracking these elements can identify areas to expedite treatment.