Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion

Felix C. Ng, Essie Low, Emily Andrew, Karen Smith, Bruce C.V. Campbell, Peter J. Hand, Douglas E. Crompton, Tissa Wijeratne, Helen M. Dewey, Philip M. Choi

Research output: Contribution to journalArticleResearchpeer-review

27 Citations (Scopus)

Abstract

Background and Purpose - Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials. Methods - Consecutive patients transferred from 3 high-volume PSCs to a single comprehensive stroke center between January 2015 and August 2016 were included in a retrospective study. Factors associated with key time metrics were analyzed with emphasis on PSC intrahospital workflow. Results - Sixty-seven patients were identified. Median age was 74 years (interquartile range [IQR], 63.5-78) and National Institutes of Health Stroke Scale 17 (IQR, 12-21). Median transfer time measured by PSC-door-to-comprehensive stroke center-door was 128 minutes (IQR, 107-164), of which 82.8% was spent at PSCs (door-in-door-out [DIDO]; 106 minutes; IQR, 86-143). The lengthiest component of DIDO was computed-tomography-to-retrieval-request (median 59.5 minutes; IQR, 44-83). The 37.3% had DIDO exceeding 120 minutes. DIDO times differed significantly between PSCs (P=0.01). In multivariate analyses, rerecruiting the initial ambulance crew for transfer (P<0.01) and presentation during working hours (P=0.04) were associated with shorter DIDO times. Conclusions - In a metropolitan hub-and-spoke network, PSC-door-to-comprehensive stroke center-door and DIDO times are long even in high-volume PSCs. Improving PSC workflow represents a major opportunity to expedite mechanical thrombectomy and improve patient outcomes.

Original languageEnglish
Pages (from-to)1976-1979
Number of pages4
JournalStroke
Volume48
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

Keywords

  • ambulances
  • health services
  • multivariate analysis
  • stroke
  • thrombectomy

Cite this

Ng, Felix C. ; Low, Essie ; Andrew, Emily ; Smith, Karen ; Campbell, Bruce C.V. ; Hand, Peter J. ; Crompton, Douglas E. ; Wijeratne, Tissa ; Dewey, Helen M. ; Choi, Philip M. / Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion. In: Stroke. 2017 ; Vol. 48, No. 7. pp. 1976-1979.
@article{470a05a977d44a85a6a0ad9f8c1de78b,
title = "Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion",
abstract = "Background and Purpose - Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials. Methods - Consecutive patients transferred from 3 high-volume PSCs to a single comprehensive stroke center between January 2015 and August 2016 were included in a retrospective study. Factors associated with key time metrics were analyzed with emphasis on PSC intrahospital workflow. Results - Sixty-seven patients were identified. Median age was 74 years (interquartile range [IQR], 63.5-78) and National Institutes of Health Stroke Scale 17 (IQR, 12-21). Median transfer time measured by PSC-door-to-comprehensive stroke center-door was 128 minutes (IQR, 107-164), of which 82.8{\%} was spent at PSCs (door-in-door-out [DIDO]; 106 minutes; IQR, 86-143). The lengthiest component of DIDO was computed-tomography-to-retrieval-request (median 59.5 minutes; IQR, 44-83). The 37.3{\%} had DIDO exceeding 120 minutes. DIDO times differed significantly between PSCs (P=0.01). In multivariate analyses, rerecruiting the initial ambulance crew for transfer (P<0.01) and presentation during working hours (P=0.04) were associated with shorter DIDO times. Conclusions - In a metropolitan hub-and-spoke network, PSC-door-to-comprehensive stroke center-door and DIDO times are long even in high-volume PSCs. Improving PSC workflow represents a major opportunity to expedite mechanical thrombectomy and improve patient outcomes.",
keywords = "ambulances, health services, multivariate analysis, stroke, thrombectomy",
author = "Ng, {Felix C.} and Essie Low and Emily Andrew and Karen Smith and Campbell, {Bruce C.V.} and Hand, {Peter J.} and Crompton, {Douglas E.} and Tissa Wijeratne and Dewey, {Helen M.} and Choi, {Philip M.}",
year = "2017",
month = "7",
day = "1",
doi = "10.1161/STROKEAHA.117.017235",
language = "English",
volume = "48",
pages = "1976--1979",
journal = "Stroke",
issn = "0039-2499",
publisher = "American Heart Association",
number = "7",

}

Ng, FC, Low, E, Andrew, E, Smith, K, Campbell, BCV, Hand, PJ, Crompton, DE, Wijeratne, T, Dewey, HM & Choi, PM 2017, 'Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion', Stroke, vol. 48, no. 7, pp. 1976-1979. https://doi.org/10.1161/STROKEAHA.117.017235

Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion. / Ng, Felix C.; Low, Essie; Andrew, Emily; Smith, Karen; Campbell, Bruce C.V.; Hand, Peter J.; Crompton, Douglas E.; Wijeratne, Tissa; Dewey, Helen M.; Choi, Philip M.

In: Stroke, Vol. 48, No. 7, 01.07.2017, p. 1976-1979.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion

AU - Ng, Felix C.

AU - Low, Essie

AU - Andrew, Emily

AU - Smith, Karen

AU - Campbell, Bruce C.V.

AU - Hand, Peter J.

AU - Crompton, Douglas E.

AU - Wijeratne, Tissa

AU - Dewey, Helen M.

AU - Choi, Philip M.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background and Purpose - Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials. Methods - Consecutive patients transferred from 3 high-volume PSCs to a single comprehensive stroke center between January 2015 and August 2016 were included in a retrospective study. Factors associated with key time metrics were analyzed with emphasis on PSC intrahospital workflow. Results - Sixty-seven patients were identified. Median age was 74 years (interquartile range [IQR], 63.5-78) and National Institutes of Health Stroke Scale 17 (IQR, 12-21). Median transfer time measured by PSC-door-to-comprehensive stroke center-door was 128 minutes (IQR, 107-164), of which 82.8% was spent at PSCs (door-in-door-out [DIDO]; 106 minutes; IQR, 86-143). The lengthiest component of DIDO was computed-tomography-to-retrieval-request (median 59.5 minutes; IQR, 44-83). The 37.3% had DIDO exceeding 120 minutes. DIDO times differed significantly between PSCs (P=0.01). In multivariate analyses, rerecruiting the initial ambulance crew for transfer (P<0.01) and presentation during working hours (P=0.04) were associated with shorter DIDO times. Conclusions - In a metropolitan hub-and-spoke network, PSC-door-to-comprehensive stroke center-door and DIDO times are long even in high-volume PSCs. Improving PSC workflow represents a major opportunity to expedite mechanical thrombectomy and improve patient outcomes.

AB - Background and Purpose - Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials. Methods - Consecutive patients transferred from 3 high-volume PSCs to a single comprehensive stroke center between January 2015 and August 2016 were included in a retrospective study. Factors associated with key time metrics were analyzed with emphasis on PSC intrahospital workflow. Results - Sixty-seven patients were identified. Median age was 74 years (interquartile range [IQR], 63.5-78) and National Institutes of Health Stroke Scale 17 (IQR, 12-21). Median transfer time measured by PSC-door-to-comprehensive stroke center-door was 128 minutes (IQR, 107-164), of which 82.8% was spent at PSCs (door-in-door-out [DIDO]; 106 minutes; IQR, 86-143). The lengthiest component of DIDO was computed-tomography-to-retrieval-request (median 59.5 minutes; IQR, 44-83). The 37.3% had DIDO exceeding 120 minutes. DIDO times differed significantly between PSCs (P=0.01). In multivariate analyses, rerecruiting the initial ambulance crew for transfer (P<0.01) and presentation during working hours (P=0.04) were associated with shorter DIDO times. Conclusions - In a metropolitan hub-and-spoke network, PSC-door-to-comprehensive stroke center-door and DIDO times are long even in high-volume PSCs. Improving PSC workflow represents a major opportunity to expedite mechanical thrombectomy and improve patient outcomes.

KW - ambulances

KW - health services

KW - multivariate analysis

KW - stroke

KW - thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=85021449309&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.117.017235

DO - 10.1161/STROKEAHA.117.017235

M3 - Article

VL - 48

SP - 1976

EP - 1979

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 7

ER -