Shortening time to reperfusion after transfer from a primary to a comprehensive stroke center

Abstract

<h3>Background</h3> This study assessed whether a quality improvement (QI) process to streamline transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) could reduce the delay of reperfusion by mechanical thrombectomy (MT). <h3>Methods</h3> From 2015 to 2017, a QI process was implemented with specific interventions to reduce door-in-to-door-out (DIDO) time in a high volume PSC, and speed up interhospital transfer and inhospital processes at the CSC. Clinical characteristics and time metrics were compared in the QI (2015–2017; n = 157) and pre-QI cohorts (2012–2014; n = 121). <h3>Results</h3> During the QI process, the median symptom onset to reperfusion time was reduced by 50 minutes (367 vs 417 minutes in the pre-QI cohort, <i>p</i> &lt; 0.04), with a substantial 40-minute DIDO reduction (78 vs 118 minutes, <i>p</i> &lt; 0.01), related to the faster administration of IV thrombolysis (median door-to-needle time: 49 vs 82 minutes, <i>p</i> = 0.0001). The door-to-door time was shortened (170 vs 205 minutes, <i>p</i> = 0.002), but not the transfer time (92 vs 87 minutes, <i>p</i> = 0.5). The QI process had no effect on the prehospital phase (77 vs 76 minutes, <i>p</i> = 0.83) and on the time from MRI imaging at the PSC to reperfusion (252 vs 288 minutes, <i>p</i> = 0.12). The rate of modified Rankin Scale score 0–2 at 90 days was comparable in the pre-QI and QI cohorts. <h3>Conclusions</h3> A QI process can reduce the reperfusion therapy delay in a distant CSC; however, we could not demonstrate that it can also improve the outcome of patients who undergo MT.