Impact of a Regional Large Vessel Occlusion Stroke Transfer Model on Door-in-door-out Times.
Carl-Lewis Valcinord1, Karen Stalin2, Kompal Kumar2, Sarah Engkjer3, Ahmedyar Hassan1, Amy Reichert4, Christopher Streib5
1Neurology, University of Minnesota, 2University of Minnesota, 3Neurology, M Health Fairview, 4M Health Fairview, 5Department of Neurology
Objective:
To assess the door-in-door-out (DIDO) times pre- and post-implementation of a protocolized large vessel occlusion (LVO) stroke transfer model.
Background:

For LVO stroke patients, the DIDO reflects the time from arrival at a non-thrombectomy-capable hospital until their transfer out to a thrombectomy-capable hospital. It is recommended that DIDO times not exceed 90 minutes, however, the average DIDO time in US hospitals in 2023 was 174 minutes.

Design/Methods:

Our hospital system consists of seven spokes and two hubs which perform thrombectomy. LVO patients presenting to our spoke hospitals are evaluated, treated, and triaged via telestroke by a stroke team. We implemented a protocol driven, regional LVO transfer model on 8/28/2023.

Pre-implementation, the transfer process was initiated and driven by each spoke hospital on a case-by-case basis in coordination with the system operations center (SOC). Examples of key changes post-implementation included: 1) assigning one hub hospital to be the primary transfer destination for each spoke hospital, 2) the SOC was no longer required to confirm the availability of a post-procedure inpatient bed before transfer, and 3) assigning transfer coordination tasks to specific providers and support staff roles.

We retrospectively reviewed all LVO patients who were transferred for thrombectomy between 1/8/2022 and 8/14/2024. We utilized the Wilcoxon rank-sum test to assess DIDO times pre- and post-implementation.



Results:
70 LVO patients pre-implementation and 55 LVO patients post-implementation met our inclusion criteria. Our cohort was 54% female, 86% white, had median NIHSS 14, and 42% received intravenous thrombolysis. Median DIDO times decreased from 117 (IQR 94-142) minutes to 90 (IQR 77-101) minutes, (p < 0.001) post-implementation of the regional LVO transfer model. 
Conclusions:
Implementation of a standardized, protocol-driven regional LVO transfer model significantly reduced median DIDO times within our hospital system.
10.1212/WNL.0000000000217568
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