Background and Issues: Our stroke center accepts patients from a large rural catchment area for advanced treatment, including endovascular intervention. An ischemic stroke transfer is initiated by the referring hospital, either by call to the transfer center with subsequent stroke team discussion, or by a formal telestroke consultation. The shortest transfer distance is 40 miles over challenging terrain, and patients are transferred by both ground and air. The stroke team needed a transfer process to expedite decision making and treatment.
Purpose: The purpose of this project is to create an interdisciplinary ischemic stroke transfer team and protocol for the transfer of patients for possible endovascular intervention to ensure safe handover of care and reduced time from onset of symptoms to reperfusion.
Methods: A multiprofessional team used Lean problem solving to develop a protocol for patients transferring for intervention consideration. The rendezvous location was identified as radiology to facilitate treatment decisions, bypassing the Emergency Department and the Neuro Intensive Care Unit (ICU). The team developed standard work to ensure that all providers would meet the patient and transferring agency in CT scan for rapid imaging, assessment, monitoring, and handover. Providers meeting in CT include nurses from Interventional Neuroradiology (INR), Neuro ICU or Emergency Department, and physicians from the Acute Stroke Team. Once a treatment decision is made the patient is moved to INR or the ICU.
Results: Time from patient arrival to arteriotomy was evaluated before and after implementation. Time range pre-implementation was 21-116 minutes (n= 12, mean= 52, median=41) and post-implementation was 17-52 minutes (n=8, mean= 31.5, median 28.5). The mean door to arteriotomy time was reduced by 20 minutes and times exhibited decreased variability demonstrating increased efficiency.
Conclusion: For patients transferring to our stroke center for advanced treatment for ischemic stroke, meeting in CT is feasible and safe. Implementation of the protocol and the response of the interprofessional team has resulted in reduced time from onset of symptoms to reperfusion and decreased variability in those times.