title: Improving Transfer Times for Acute Ischemic Stroke Patients to a Comprehensive Stroke Center.
abstract: OBJECTIVE
  The transfer of acute ischemic stroke (AIS) patients to a comprehensive stroke center (CSC) must be rapid. Delays pose an obstacle to time-sensitive stroke treatments and, therefore, increase the likelihood of exclusion from endovascular stroke therapy. This study aims to evaluate the impact of the Stroke Rescue Program, with its goal of minimizing interfacility transfer delays and increasing the number of transport times completed within 60 minutes.
  
  
  METHODS
  The Stroke Rescue Program was initiated to facilitate the rapid transfer of AIS patients from regional primary stroke centers (PSCs) to the network's CSC. The transfer process was divided into 3 time elements: transport 1 time (initial phone call from the PSC until emergency medical service [EMS] arrival at the PSC), emergency department (ED) time (EMS PSC arrival to PSC departure), and transport 2 time (PSC departure to CSC arrival). The total transport time target was set at less than 60 minutes. Protocols and procedures were implemented with a focus on decreasing the ED time.
  
  
  RESULTS
  Comparing baseline (preimplementation) quarter (n = 21) to postproject quarter (1 year later, n = 31), the percent transported within 60 minutes increased from 62% to 81%. A statistically significant improvement was seen for both median ED time (23 minutes versus 14 minutes; U = 171, P < .01) and median total transport time (56 minutes versus 44 minutes; U = 199, P < .05).
  
  
  CONCLUSIONS
  Interfacility transfer protocols minimizing the time paramedics spend in a PSC ED can significantly reduce total transfer time to a comprehensive stroke center.
authors.affiliation: Department of Neurology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, New York.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Kodankandath
authors.affiliation: Department of Neurology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Wright
authors.affiliation: Department of Workforce Safety, Northwell Health.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Power
authors.affiliation: Department of Informatics and Quality, Northwell Health.
authors.forename: Marcella
authors.initials: M
authors.lastname: De Geronimo
authors.affiliation: Department of Neurology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Libman
authors.affiliation: Department of Emergency Medicine, Hofstra Northwell School of Medicine.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kwiatkowski
authors.affiliation: Department of Neurology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, New York. Electronic address: jkatz2@northwell.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Katz
mesh_terms: D002545:Brain Ischemia / Q000150:complications*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010360:Patient Transfer; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute ischemic stroke; drip-and-ship transfer; endovascular stroke therapy; stroke quality; stroke transfer; thrombolysis