Abstract WP039: LVO Transfer Process within the hospital system

Background: Reperfusion with endovascular thrombectomy (EVT) is a time-sensitive procedure that improves functional outcomes in acute LVO stroke. Per the American Heart Association Target Stroke Guidelines, LVO stroke transfer times (e.g. door-in-door-out [DIDO] times) should not exceed 90 minutes; however, the average DIDO time in the United States in 2023 was 174 minutes. We report DIDO times within our hospital system before and after a protocolized system-wide LVO transfer process. Methods: Our hospital system consists of seven spoke hospitals and two EVT-capable centers. LVO transfer process was initiatially driven by each spoke hospital on a case by case basis together with the systems operation center (SOC). As part of a multidisciplinary quality improvement initiative, multiple interventions were made to streamline EVT transfers within a unified regional LVO transfer model. These interventions included: 1) assigning each spoke hospital a specific EVT-capable hospital for LVO transfers, 2) no longer requiring the SOC to confirm a post-procedure bed prior to initiating transfer, and 3) coordinating transfer specific tasks were assigned and protocolized. We retrospectively reviewed consecutive LVO transfer patients between dates 1/8/2022 - 8/14/2023. The regional LVO transfer model was implemented on 8/28/2023. We report the patient demographics in Table 1. We analyzed DIDO times pre- and post-implementation and tested for statistical significance using Wilcoxon Rank-Sum testing. Results: Our sample included 70 patients pre-implementation and 61 post-implementation who met our criteria for inclusion in the study. Patient characteristics, including age, sex distribution, baseline NIHSS are summarized in Table 1. Median DIDO time decreased from 117 min to 93 min following protocol implementation, representing a reduction of 26%. The improvement in DIDO times reached statistical significance p = 0.001. Conclusion: Implementation of a standardized, protocol-driven LVO transfer model across our hospital system significantly reduced DIDO times and improved adherence to national benchmarks. Although further optimization and larger sample sizes are warranted, our findings suggest that system-wide standardization can meaningfully accelerate time to reperfusion for LVO patients. These results underscore the importance of clear, parallel workflows that underscore the importance of meeting AHA target guidelines and patient care.