The median time to transfer stroke patients from the emergency department to an appropriate treatment site was 174 minutes, longer than the recommended 120 minutes, researchers report.
. The most common reasons for transfer were advanced stroke care , evaluation for endovascular therapy , and IV thrombolysis management .Emergency Medical Services prenotification, by which ambulance staff alert the receiving hospital that a patient suspected of having had a stroke is en route, was used in 43.9% of patients overall.
On the other hand, ischemic stroke patients who are not candidates for endovascular therapy may need additional workup and treatment, including CT angiogram and IV thrombolysis, so the decision-making is"not as straightforward," and this may affect transfer time, he said. Urban hospital location was also significantly associated with prolonged door-in, door-out times. This might be because city hospitals have more resources to use for patients, which could delay the transfer, said Prabhakaran.
This should start with EMS prenotification and should include standardized screening for stroke upon ED arrival, protocols for moving patients to imaging, and rapid communication with the receiving center, he said. "Get With the Guidelines has a track record of success as a tool to quantify, trend, and improve stroke care," said Mullen."Hopefully these data can be leveraged for future quality improvement programs to reduce door-in, door-out time overall and to reduce or eliminate the observed disparities."
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