Background and Issues: Stroke care delivery continues to undergo dynamic changes as evolving treatment extends the critical reperfusion time window. Stroke centers have responded by improving approaches to rapidly transport patients receiving alteplase or who have been identified as endovascular eligible. Limited literature exists discussing interfacility transport during ischemic stroke reperfusion.
Purpose: We describe the outcomes of a quality assurance (QA) process of auditing interfacility transfers to ensure adherence to protocol when transporting drip and ship patients. This approach has been recognized as a best practice during CSC certification.
Methods: As the number of interfacility transfers increased, the stroke team met with the aeromedical and critical care ground transport team to develop ongoing QA processes for the care of patients during transport. Competencies and education for crew and ongoing quality metrics were established. Revisions were made to stroke transport protocols to more closely align with the American Stroke Association guidelines. Retrospective chart review of protocol adherence and complications was completed monthly with feedback provided to the transport teams.
Results: Since 2015 this CSC admitted 2911 stroke patients with 860 neuro transfers by 4 helicopters and 2 ground critical care transport teams. Retrospective analysis of 116 drip and ship transport charts was completed. There were no life-threatening complications or major neurological deterioration in our sample. One airway event resolved with intubation in transit. Common protocol deviations involved timing of vital signs and neuro checks and titration of vasoactive medications.
Conclusion: Logistics of interfacility transport continues to evolve as more patients are referred to CSC’s for advanced interventions. Access to highly-trained transport teams provides rapid and safe passage during reperfusion. Crew education and ongoing QA encourages continual performance improvement, improves communication and reinforces protocol adherence. Dissemination of best practices is critical as limited specialized neurovascular services will continue to require interfacility patient movement to access advanced stroke resources.