Abstract Body: Background: Swift intervention is crucial to achieving optimal outcomes in patients presenting with an acute ischemic stroke due to large vessel occlusion (LVO). The goal of this real-world, retrospective, records-based study was to assess process components driving door-to-reperfusion times across 16 facilities.
Methods: A total of 1,362 patient records from a large healthcare system between August 2020 to December 2021 were reviewed retrospectively across 16 facilities throughout the United States. Each facility (n=16) completed a 196-question care pathway survey with clear differentiation between direct arrival and interfacility transfer modes of arrival. Elastic Net Regularization was used to account for patient-level characteristics in a subsequent multi-variable linear regression, revealing care pathway indicators associated with decreased door-to-reperfusion times. Actionable indicators were categorized and ranked using statistically significant coefficients and p-values. Confounders, (e.g. facility-related volume, level of stroke certification) were accounted for in the analysis and, subsequently, results were interpreted by a 16-member Nurse Working Group and an 8-member Physician Working Group. Preferred practice recommendations for thrombectomy-capable facilities were generated.
Results: Overall, mean reperfusion rate (TICI 2B or higher) was 90.3% and mean door-to-reperfusion time was 116 minutes (SD ± 56, 108 mins (71, 152)). Mean door-to-puncture time was 83 minutes (74 min, (43,109)). Significant and highly-ranked care pathway indicators were classified into three categories: people, process, and technology. Programs with evidence of (1) full integration of CT techs into stroke alerts; (2) neuro-dedicated personnel prior to and at time of arrival; (3) standardized intake and communication protocols from door to puncture; (4) remote access for rapid imaging interpretation; and (5) established protocols for baseline imaging and anesthesia were associated with significantly higher time efficiencies across the continuum-of-care.
Conclusions: Establishing evidence-based, preferred practices for mechanical thrombectomy across each care segment from door to recanalization can enhance stroke care pathway tactics to optimize patient outcomes. Future work will be to evaluate changes in time to reperfusion post-implementation of these preferred practices and to assess impact on patient outcomes.