Objective:

To determine the impact of Stroke Transfer Coordinators (STC) on door-to-intervention times.

Background:

Treatment of hyperacute ischemic stroke due to large vessel occlusion (LVO) is time-critical, requiring a coordinated team response.  The Joint Commission has set targets for door-to-skin puncture and door-to-reperfusion, but these targets can be a challenge to attain, particularly with patients transferred from rural communities.  A “Stroke Alert” process is common in primary and comprehensive stroke centers, activating physicians, laboratory, radiology, and nursing support.  

In 2021, use of Viz.AI was implemented and six Stroke Transfer Coordinators (STC) were hired, whose responsibilities are attending stroke alerts, monitoring CT scans through Viz.AI, and facilitating transfer of patients with LVO for thrombectomy.  Viz.AI allows streamlined communication amongst the treatment team (MDs, ED Charge, Bed Capacity). The STC also facilitates patient transport to the intervention suite and tracks data.

Design/Methods:

This is a single center retrospective cohort study. Basic demographic data, presence of LVO, time of last known well, time of imaging, time of transfer acceptance, NIHSS, and thrombolysis prior to transfer were recorded.  Door-in-door out, door-to-angiogram, and door-to-skin puncture times were also collected.  We compared and analyzed data from 12 months prior to (August 2020-July 2021), and the 12 months following (August 2021 to July 2022), the implementation of STCs. 

Results:

Total number of Stroke Alerts in the pre-STC time period was 1479, with 136 thrombectomy alerts.  Post-TSC the total number of SA was 1306, with 179 thrombectomy alerts. The mean door-to-intervention time pre-STC was 24 minutes (median=25 minutes).  Post implementation of the STC, the mean door-to-intervention time was 17 minutes (median= 12 minutes). 

Conclusions:

The utilization of STC’s improved the door-to-intervention time by mean of 7 minutes (median= 13 minutes). When every minute counts in re-establishing brain perfusion, this improvement may lead to better patient outcomes.  Further study is necessary.