Central Triage of Acute Stroke Patients Across a Distributive Stroke Network Is Safe and Reduces Transfer Denials

 'Safely',  not even measuring 100% RECOVERY. This is the reason we need survivors in charge.

Central Triage of Acute Stroke Patients Across a Distributive Stroke Network Is Safe and Reduces Transfer Denials

Derek Holder

,

Kevin Leeseberg

,

James A. Giles

,

Jin-Moo Lee

,

Sheyda Namazie

,

Andria L. Ford

Originally published22 Jun 2021https://doi.org/10.1161/STROKEAHA.120.033018Stroke. 2021;52:2671–2675

Abstract

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Background and Purpose:

Mechanical thrombectomy has dramatically increased patient volumes transferred to comprehensive stroke centers (CSCs), resulting in transfer denials for patients who need higher level of care only available at a CSC. We hypothesized that a distributive stroke network (DSN), triaging low severity acute stroke patients to a primary stroke center (PSC) upon initial telestroke consultation, would safely reduce transfer denials, thereby providing additional volume to treat severe strokes at a CSC.

Methods:

In 2017, a DSN was implemented, in which mild stroke patients were centrally triaged, via telestroke consultation, to a PSC based upon a simple clinical severity algorithm, while higher acuity/severity strokes were triaged to the CSC. In an observational cohort study, data on acute ischemic stroke patients presenting to regional community hospitals were collected pre- versus post-DSN implementation. Safety outcomes and rate of CSC transfer denials were compared pre-DSN versus post-DSN.

Results:

The pre-DSN cohort (n=150), triaged to the CSC, had a similar rate of symptomatic intracerebral hemorrhage and discharge location compared with the post-DSN cohort (n=150), triaged to the PSC. Time to stroke unit admission was faster post-DSN (2 hours 40 minutes) versus pre-DSN (3 hours 29 minutes; P<0.001). Transfer denials were reduced post-DSN (3.8%) versus pre-DSN (1.8%; P=0.02), despite an increase in telestroke consultation volume over the same period (median, 3 calls per day pre-DSN versus 5 calls per day post-DSN; P=0.001). No patients who were triaged to the PSC required subsequent transfer to the CSC.

Conclusions:

A DSN, triaging mild ischemic stroke patients from community hospitals to a PSC, safely reduced transfer denials to the CSC, allowing greater capacity at the CSC to treat higher acuity stroke patients.

Footnotes

*D. Holder, K. Leeseberg, and J.A. Giles contributed equally as cofirst authors.

†S. Namazie and A.L. Ford contributed equally as cosenior authors.

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.120.033018.

For Sources of Funding and Disclosures, see page 2674.

Correspondence to: Andria L. Ford, MD, MSCI, Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, Email forda@wustl.edu

Sheyda Namazie, MD, MBA, BJC Healthcare, Center for Clinical Excellence, 8300 Eager Rd, Suite 400, St. Louis, MO 63144, Email sheyda.namazie-kummer@bjc.org