Intra-arterial therapy for large vessel occlusion has recently been shown to improve outcomes in certain acute stroke patient populations. This had led the AHA/ASA to release guidelines recommending endovascular procedures for selected patients and that systems of care need to be organized to facilitate the delivery of this treatment.
Unfortunately, not all patients eligible for endovascular therapy present to facilities capable of delivering endovascular treatment, and need to be transferred to larger hospitals, most often comprehensive stroke centers for the procedure to be performed. The transfer process is complex and often involves multiple teams of physicians and administrative personnel to coordinate the transfer of the patient. The complexity can often lead to delays in arrival of the patient to the hub and possibly lead to less than ideal outcomes or at times often exclude the patient from the procedure due to the limited time window. Currently, there are no standard time metrics recommended for the IAT transfer process.
We therefore aim to describe the current landscape of IAT transfer times at Texas CSCs to identify barriers/delays in the transfer process (phase 1). Once we have completed specific aims 1 and 2, we will propose the second phase of this study to address aim 3. We will determine which hospitals have the longest and shortest transfer times and share the data with each of the LSS hospitals. Our objective is for each hospital to learn from each other and evaluate best practices associated with shorter transfer times that could be implemented throughout the network. We will propose specific process improvement initiatives depending on the data analysis from phase 1.
By identifying potential barriers/delays to access to IAT, quality improvement process can be implemented to improve the current system of transfer of patients from PSC to CSC for evaluation of IAT. Faster transfer time may lead to an increase number of patients undergoing IAT translating into better outcomes.