Abstract 77: A Regional Transfer Center Pilot Improves Door-in-Door-out Time in a Large Integrated Healthcare System

Background: Successful treatment of patients with large vessel occlusions (LVO) is time dependent, yet timely transfers between hospitals for endovascular therapy (EVT) can be challenging. At Kaiser Permanente Northern California (KPNC) a wide variety of ambulance and EMS agencies may be involved in Urgent interfacility transfers. We evaluated a region-wide pilot utilizing a central transfer center to facilitate these transfers within a large integrated healthcare system.

Methods: KPNC implemented a regional transfer center (TC) in March 2023, which arranged transfers for 17 of 19 primary stroke centers (PSC) from 8am to 9pm. Two centers were excluded as they were utilizing 911 transport rather than interfacility ambulance hub transfers. The study cohort included all stroke patients arriving to a PSC with LVO who were transferred to one of our Comprehensive Stroke Centers for EVT from 3/6/23 through 8/4/23. Data were compared to a similar cohort 10/6/23 through 3/5/23 (pre-TC). All patients were evaluated by teleneurologists on arrival, who requested initiation of ambulance transfer. Before TC, the ambulance request was made by the local ED facility; after the implementation of the TC, ambulance was arranged by the TC and communicated with teleneurology and the local ED. Door in door out (DIDO) times were measured for all transfers.

Results: The pre-TC group had 81 transfers. The post-TC group had 68 patients. After TC, median DIDO dropped from 105 minutes to 83.5 minutes (p=0.02). The percent of patients transferred within 90 minutes rose from 41% to 57% (p=0.04) and the percent transferred with 75 minutes rose from 25% to 35% (p=0.14). Similar improvements were seen regardless of sex or ethnicity [Table].

Conclusions: Preliminary results show a significant improvement in DIDO times with initiation of a centralized TC to facilitate LVO transfers in a large integrated delivery system. Systems wishing to improve DIDO performance should consider implementing a similar TC.