Abstract Body: Introduction: Patent Foramen Ovale (PFO) contributes to a quarter of Embolic strokes of Undetermined Source (ESUS). Although benefit of PFO closure in selected patients has been demonstrated, our workflow resulted in a low rate of PFO evaluation for closure. The aim of the PFO-ACCESS program (which included implementation of the Viz.ai PFO-specific communications module) was to determine any change in PFO management due to improved communication between stroke and interventional cardiology (IC) teams.

Methods: In this Quality Improvement (QI) project, we compared pre-PFO ACCESS (12/22-11/23) to post- periods (11/23-6/24) for PFO referrals. The Viz.ai PFO module was deployed to the stroke team and IC team members. No other workflow changes were introduced. Key performance indicators (KPIs) included referral frequency, PFO closure rates, and referral- related time intervals. Statistical comparisons utilized Mann-Whitney U tests.

Results: The post-implementation period noted a 492% PFO referral increase (11,65(annualized);p<0.0001). PFO closure number totals showed a 186% increase pre- vs. post- (6,17(annualized);p=0.02), with PFO closure of percentage of total referred cases not increasing (54.55%,26.32%;p=0.08). Time comparisons showed a non-significant decrease in median “referral sent to referral viewed” (10:37hrs, 1:08hrs; p=0.73), “referral sent to referral accepted” (10:37hrs, 1:03hrs; p=0.67) time interval, and “referral sent to closure” time interval (102 days, 97 days; p=0.55).

Conclusions: The PFO-ACCESS program with Viz.ai PFO module use resulted in a 492% increase in PFO referrals and a 186% increase in closures due to enhanced communication and efficiency in managing PFO related stroke cases. Though increased number of referrals and closures were observed, the PFO closure percentage of total referred cases did not increase indicating selective case management. The higher number of PFO closures shows that more patients are appropriate for PFO closure consideration. Future efforts should focus on expanding outpatient use and increasing provider education to optimize PFO management.