Abstract 113: Streamlined Workflows for Triage and Transfer Reduce Door-to-Puncture Time in Mechanical Thrombectomy

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Introduction: Rapid thrombectomy produces improved neurological outcomes in select patients with acute ischemic stroke. Here, we detail process improvements to reduce door-to-puncture (DTP) times in a multi-hospital network organized around an endovascular-capable center (ECC).Methods: A lean workflow was adopted to minimize time door-to-imaging and imaging-to-puncture time intervals. Key features of this workflow included minimalist and parallelized clinical and radiological evaluation with single-session CT and CT angiography (CTA) and point-of-care image interpretation, IV fibrinolysis in the CT suite for patients presenting to the ECC, pre-transfer IV fibrinolysis and CTA for patients transferred to the ECC, immediate transport from the CT suite to the angiography suite (potentially before neurointerventional team arrival), and minimalist setup in the angiography suite. DTP time was tracked between January 2015 and December 2015. Trends over time were characterized using a linear regression model.Results: The number of thrombectomies performed each quarter increased by 173% (p=0.0017), and there was an increase in the proportion of transferred patients that underwent pre-transfer CTA (p=0.0438) (Fig. 1). Quarterly median DTP time decreased by 74% (147 minutes to 39 minutes, p<0.0001); this decrease was greatest in transferred patients with pre-transfer CTA, in whom DTP time decreased 81% (129 minutes to 25 minutes, p=0.0008) (Fig. 2).Conclusions: Workflow improvements to streamline in-hospital evaluation at an ECC and perform critical workup such as CTA at referring hospitals before transfer to an ECC can dramatically improve DTP time.

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