Study Finds Significant Delays in Interhospital Transfer Times for Patients with Acute Ischemic or Hemorrhagic Stroke

According to study results published in JAMA, the median interhospital transfer time for patients with acute ischemic or hemorrhagic stroke was 174 minutes, significantly longer than the Joint Commission and Brain Attack Coalition recommended transfer time (≤120 minutes). Researchers also found that transfer delays were associated with a variety of factors including age >80 years, female sex, and non-Hispanic Black and Hispanic patient populations.

The retrospective study included data from 108,913 patients (mean [SD] age, 66.7 [15.2] years) with ischemic or hemorrhagic stroke transferred from the emergency department (ED) of 1925 US registry-affiliated hospitals to other acute care hospitals between January 2019 and December 2021. Researchers used generalized estimating equation (GEE) regression models to analyze the door-in-door-out time (time of transfer out minus time of arrival to the transferring ED). The median door-in-door-out time was 174 minutes (IQR, 116-276 minutes), with only 29,741 patients (27.3%) having a door-in-door-out time ≤120 minutes.

Subgroup analysis revealed that significantly longer median door-in-door-out times were associated with the following factors: age 80 years or older (vs 18-59 years; 14.9 minutes, 95% CI, 12.3 to 17.5 minutes), female sex (5.2 minutes; 95% CI, 3.6 to 6.9 minutes), non-Hispanic Black vs non-Hispanic White (8.2 minutes, 95% CI, 5.7 to 10.8 minutes), and Hispanic ethnicity vs non-Hispanic White (5.4 minutes, 95% CI, 1.8 to 9.0 minutes). Furthermore, shorter median door-in-door-out times were associated with the following factors: emergency medical services prenotification (−20.1 minutes; 95% CI, −22.1 to −18.1 minutes), National Institutes of Health Stroke Scale (NIHSS) score exceeding 12 vs a score of 0 to 1 (−66.7 minutes; 95% CI, −68.7 to −64.7 minutes), and patients with acute ischemic stroke eligible for endovascular therapy vs the hemorrhagic stroke subgroup (−16.8 minutes; 95% CI, −21.0 to −12.7 minutes).

According to the Joint Commission, “reducing the time stroke patients remain in the ED can improve access to a higher-level of stroke care, surgical intervention, or advanced intra-arterial endovascular treatments, and increase quality of care.” This study identifies factors associated with longer interhospital transfer times that can serve as key targets for achieving shorter door-in-door-out times and thus the quality of care for acute ischemic or hemorrhagic stroke patients.