Introduction:
Time-sensitive therapies can be delayed during weekends or off-hours. Regional systems of care require interfacility transfers from
Primary Stroke Centers
(PSC) to
Comprehensive Stroke Centers
(CSC).
Door-in to door-out
(DIDO) time, an emerging performance measure, is a modifiable factor in time to thrombectomy. Off-hours presentation has been associated with longer
Door-To-Needle
(DTN) time, however its effect on DIDO time is unknown.
Hypothesis:
Presentation during off-hours (before 8 AM, after 5 PM or on weekends) prolongs DIDO time.
Methods:
Retrospective review of transfers for CT perfusion or thrombectomy from 4 PSC to a CSC between 1/2017 and 6/2019. We used Mann-Whitney for hypothesis testing and Spearman’s correlation.
Results:
Sixty-seven persons were included, of which 36 were male, 31 received IV tPA, 40 presented during off-hours. Median (upper and lower quartile) for age, NIHSS, DTN and DIDO were 74 (61-83) years, 17 (12-23) points, 37 (31-54) and 98 (77-127) minutes, respectively. Off-hours presentation did not prolong DIDO time (p=0.32, image) nor affect any interval in the sequence door-in,
non-contrast CT
(nCT), IV tPA,
CT Angiogram
(CTA) initiation, CTA interpretation, door-out; or
door-in at PSC to groin puncture
(DTGP) time. Transport from PSC to CSC was slower off-hours (p=0.04). On post-hoc analyses, DIDO correlated with door-in to nCT interpretation time (r
s
=0.27, p=0.02), nCT interpretation to consulting neurointerventionalist (r
s
=0.59, p<0.01) and their acceptance of a transfer (r
s
=0.37, p=0.01); door-in to CTA initiation (r
s
=0.77, p<0.01), CTA initiation to interpretation (r
s
=0.61, p<0.01), and DTGP time (r
s
=0.85, p<0.01).
Conclusions:
Off-hours presentation is not associated with prolonged DIDO time in patients transferred for possible thrombectomy. Time to calling neurointerventionalist and initiation and interpretation of CTA contributes to DIDO, and may be targets for improvement to expedite transfers.
Variable Impact of State Legislative Advocacy on Registry Participation and Regional Systems of Care Implementation