Abstract WP369: Triaging Acute Ischemic Stroke Patients Across a Network of Hospitals is Safe and Reduces Transfer Denials for Thrombectomy
| Autor: | James A Giles, Sheyda Namazie-Kummer, Jin-Moo Lee, Andria L. Ford, Derek Holder, Kevin Leeseberg |
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| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Stroke. 50 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/str.50.suppl_1.wp369 |
| Popis: | Introduction: The introduction of thrombectomy into evidence-based stroke care has dramatically increased the volume of stroke patients transferred to comprehensive stroke centers (CSC), often overwhelming their capacity. This has led to increased transfer denials of severe stroke patients who needed thrombectomy. Hypothesis: A “distributive stroke network” (DSN) to triage low severity acute stroke patients to a primary stroke center (PSC) upon initial neurology consultation will be safe, thereby providing additional volume to treat severe strokes at a CSC. Methods: A clinical severity algorithm for external consultations based on NIHSS and time since last known well was created to triage mild acute ischemic stroke patients (both tPA-treated and untreated) to the PSC, while triaging more severe strokes to the CSC. We evaluated clinical outcomes, safety endpoints, stroke consultation volumes, and transfer denials by comparing a stroke cohort after DSN implementation, to a cohort (matched for NIHSS and acuity) admitted to the CSC prior to DSN implementation. Results: The pre-DSN CSC cohort had similar demographics to the post-DSN PSC cohort. Safety outcomes (symptomatic hemorrhage or the need for PSC to CSC transfer) and favorable discharge outcome (home/inpatient rehabilitation vs. nursing home/death) did not differ between pre- and post-DSN cohorts. The post-DSN PSC cohort had a faster time from consult to admission (3 vs. 5 hours) and shorter hospital length of stay (LOS) (2 vs. 3.5 days) compared to the pre-DSN CSC cohort. After DSN implementation, there were fewer CSC stroke transfer denials. Total consultation rates increased over the same period. Conclusion: Triaging external patients to a PSC or CSC during initial consultation (distributive stroke network) based on stroke severity and acuity significantly reduced transfer denials to the CSC. In addition, this DSN algorithm was safe, led to faster admission, and a shorter LOS. |
| Databáze: | OpenAIRE |
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