Abstract P166: The Primary Stroke Center Transfer Experience to Higher Levels of Care: A Qualitative Study
Background: Transfer times from primary stroke centers/acute stroke ready hospitals (PSCs/ASRHs) to higher levels of care have been shown to be excessive in many cases, promoting some to believe that bypass regulations should be instituted. Yet barriers to rapid transfer remain undescribed in the literature. The purpose of this work is to investigate these issues and the locus of control for transfer time delays. Methods: Six national focus groups with PSC/ASRH staff experienced with stroke transfers were conducted by web conference. Interviews were conducted using pre-scripted open-ended questions; information was recorded, and data were transcribed, for theme identification. Results: Participants were from Northeast, Mid-Atlantic, Southeast, Midwest, and West Coast USA. Data were grouped into 3 main categories representing where transfer problems initiated. Themes emerging within the Internal PSC/ASRH Category were exclusively emergency department (ED) physician focused including knowing how/when to use advanced imaging and telemedicine resources. Of note, all participants were compliant with door-to-CT and treatment time metrics. Within the Transport Category , themes included inadequate time-to-response by ground and air ambulances, and specialty transport costs. Within the Internal Comprehensive Stroke Center (CSC) Category , themes included complex communication, overwhelmed systems, and poor guidance on patient selection. Conclusions: While ED physician contributors to transfer delays are within the control of PSCs/ASRHs, more challenging factors to rapid transfer include factors within transport systems and CSCs themselves. Quantification of these factors is warranted to support transfer system redesign with rapid access to care.