Abstract Body: Background: Rapid transfer of patients with large vessel occlusion (LVO) from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs) is crucial for optimizing outcomes. Door-in door-out (DIDO) time, the interval from arrival at the PSC to discharge for the CSC, is a key determinant of treatment timeliness and patient prognosis. Stroke Programs often hone in on benchmark times as goals for quality improvement (QI) initiatives, however, completing an initiative may not always be the end of the process.
Methods: This study evaluates the impact of a continuous process improvement initiative aimed at reducing DIDO times for LVO patients transferred between PSCs and CSCs. Four distinctive time periods were defined, 1) initial QI to meet benchmark, 2) No active QI, 3) Renewal of QI, 4) Advancement of QI. At each stage intervention focused on staff education and fostering collaboration between a central transfer center, critical care transport teams, and stroke program staff with the current phase introducing additional targets beyond the benchmark of under 90 minutes for 50% of the cases transferred for LVO.
Results: Data collected over an 8-year period where the transfer process was continually refined were analyzed. Overall, the conceptualization of progress towards the goal of the QI, impacted both mean transfer times [F(3,104) = 4.01, p= .01)] and the rate of compliance to benchmark [χ² = (2, N = 107) = 19.19, p <.001]. The initial QI project targeting meeting the 90-minute benchmark resulted in a mean DIDO time of under 90 minutes with a compliance rate of 56%. During phase 2, mean DIDO time increased to 103 minutes with compliance dropping to 13%. A renewal of the QI improved transfer times and compliance rate back within acceptable limits (86 min. and 67%, respectively). During Phase 4, mean DIDO time dropped to 72 minutes and compliance increased to 90%.
Conclusion: Continuous process improvement strategies focusing on staff education and interdepartmental collaboration effectively reduced DIDO times for LVO patients transferred from PSCs to CSCs. These findings highlight the importance of setting new goals once a QI has succeeded. Continual structured interventions are paramount in optimizing acute stroke care systems. Future research should explore additional factors influencing transfer times and further refine strategies to expedite care for stroke patients requiring specialized interventions at CSCs.