Abstract
Study objective: Acute stroke patients often require interfacility transfer from primary stroke centers to comprehensive stroke centers. Given the time-sensitive benefits of endovascular reperfusion, reducing door-in-door-out time at the primary stroke center is a target for quality improvement. We sought to identify modifiable predictors of door-in-door-out times at 3 Chicago-region primary stroke centers. Methods: We performed a retrospective analysis of consecutive patients with acute stroke from February 1, 2018 to January 31, 2020 who required transfer from 1 of 3 primary stroke centers to 1 of 3 affiliated comprehensive stroke centers in the Chicago region. Stroke coordinators at each primary stroke center abstracted data on type of transport, medical interventions and treatments prior to transfer, and relevant time intervals from patient arrival to departure. We evaluated predictors of door-in-door-out time using median regression models. Results: Of 191 total patients, 67.9% arrived by emergency medical services and 57.4% during off-hours. Telestroke was performed in 84.2%, 30.5% received alteplase, and 48.4% underwent a computed tomography (CT) angiography at the primary stroke center. The median door-in-door-out time was 148.5 (interquartile range 106 to 207.8) minutes. The largest contributors to door-in-door-out time, in minutes, were CT to CT angiography time (22 [7 to 73.5]), transfer center contact to ambulance request time (20 [8 to 53.3]), ambulance request to arrival time (20.5 [14 to 36]), and transfer ambulance time at primary stroke center (26 [21 to 35]). Factors associated with door-in-door-out time were (adjusted median differences, in minutes [95% confidence intervals]): CT angiography performed at primary stroke center (+39 [12.3 to 65.7]), walk-in arrival mode (+53 [4.1 to 101.9]), administration of intravenous alteplase (-29 [-31.3 to -26.7]), intubation at primary stroke center (+23 [7.3 to 38.7]), and ambulance request by primary stroke center (-20 [-34.3 to -5.7]). Conclusion: Door-in-door-out times at Chicago-area primary stroke centers average nearly 150 minutes. Reducing time to CT angiography, receipt of alteplase, and ambulance request are likely important modifiable targets for interventions to decrease door-in-door-out times at primary stroke centers.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 674-681 |
| Number of pages | 8 |
| Journal | Annals of Emergency Medicine |
| Volume | 78 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2021 |
Funding
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). The ESPEED study is funded by the Agency for Healthcare Research and Quality ( R18HS025359 ). Dr. Shyam Prabhakaran reports a grant from the Agency for Healthcare Research and Quality during the conduct of the study, grants from NIH / NINDS , personal fees for consulting from Abbvie, Inc., and honorarium from UpToDate. Rebeca Khorzad reports a grant from the Agency for Healthcare Research and Quality and personal fees from the University of Chicago during the conduct of this study. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The ESPEED study is funded by the Agency for Healthcare Research and Quality (R18HS025359). Dr. Shyam Prabhakaran reports a grant from the Agency for Healthcare Research and Quality during the conduct of the study, grants from NIH / NINDS, personal fees for consulting from Abbvie, Inc., and honorarium from UpToDate. Rebeca Khorzad reports a grant from the Agency for Healthcare Research and Quality and personal fees from the University of Chicago during the conduct of this study.Dr. Christopher T. Richards reports a grant from the Agency for Healthcare Research and Quality during the conduct of this study; support for conference travel from the American Heart Association and Illinois EMT Association; and his unpaid role on the American Stroke Association Advisory Board. Dr. William J. Meurer reports grants from the National Institutes of Health and the Agency for Healthcare Research and Quality during the conduct of this study; consulting income from Berry Consultants; and his methodology statistics editing role for Annals of Emergency Medicine as well as occasional medicolegal consulting. Dr. Scott J. Mendelson reports a grant from the Agency for Healthcare Research and Quality during the conduct of this study and his role as a Committee Member of the National Quality Forum, Neurology Standing Committee. Zahra Parnianpour, Elida Romo, Dr. Jungwha Lee, and Dr. Jane L. Holl all report a grant from the Agency for Healthcare Research and Quality during the conduct of this study.
ASJC Scopus subject areas
- Emergency Medicine