Introduction and purpose

Timely inter-facility transfer of thrombectomy-eligible patients is a mainstay of Stroke Systems of Care. We investigated transfer patterns among stroke certified hospitals in the Dallas-Fort Worth (DFW) Metroplex (19 counties, 9,286 sq mi, > 7.7 million people), by hospital network and stroke center status.

Methods

We conducted a North Central Texas Trauma Regional Advisory Council (NCTTRAC) Stroke Regional Care Survey at all 44 centers involved in the treatment of MT-eligible ischemic stroke patients between June-September 2019, with a response rate of 100%. All hospitals identified network status, stroke designation – Acute Stroke Ready Hospital (ASRH), Primary Stroke Center (PSC), Comprehensive Stroke Center (CSC) - and geographic location. Stroke Assessment and Large Vessel Occlusion (LVO) screening tool use was evaluated. The distance between the sending and receiving facility was calculated using GPS coordinates. If the closest CSC was not used, the average distance between the selected and the closest CSC was geospatially mapped via R statistical analysis software (Vienna, Austria) gmapsdistance package.

Results

Of the 44 facilities, 6 were ASRHs, 27 were PSCs, 11 were CSCs. Seventy-seven percent (n=34) belonged to one of four hospital networks. All facilities used stroke assessment tools; 57% completed LVO screening. There was significant heterogeneity in inter-facility transfer patterns with no regional standardization. Seventeen percent of ASRHs (n=1) and 56% of PSCs (n=15) conducted inter-facility transfers using ground transportation via EMS. Sixty percent of non-network facilities transferred to the closest CSC. Of the remaining 40%, the average distance between the closest and the selected CSC was 1.5 miles (min max 0.2-2.9 miles). Seventeen percent of network facilities transferred to the closest CSC. Among the remaining 83%, the average distance between the closest and the selected CSC was 4.1 miles (min-max 1-8 miles).

Conclusions

Non-network facility status increased the likelihood of transfer to the closest Comprehensive Stroke Center. Transfer distance variability among network facilities may contribute to delays in reperfusion therapy.

中文翻译：

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区域卒中认证医院间机构间转移的“网络效应”

简介和目的

符合血栓切除术条件的患者的及时跨机构转移是 Stroke Systems of Care 的中流砥柱。我们根据医院网络和卒中中心状态调查了达拉斯-沃思堡 (DFW) 大都会（19 个县，9,286 平方英里，> 770 万人）中风认证医院之间的转移模式。

方法

我们在 2019 年 6 月至 9 月期间在所有 44 个参与治疗符合 MT 条件的缺血性中风患者的中心进行了中北部德克萨斯创伤区域咨询委员会 (NCTTRAC) 中风区域护理调查，响应率为 100%。所有医院都确定了网络状态、卒中指定——急性卒中准备医院 (ASRH)、初级卒中中心 (PSC)、综合卒中中心 (CSC) 和地理位置。评估了中风评估和大血管闭塞 (LVO) 筛查工具的使用。使用 GPS 坐标计算发送和接收设施之间的距离。如果不使用最近的 CSC，则通过 R 统计分析软件（奥地利维也纳）gmapsdistance 包对所选和最近的 CSC 之间的平均距离进行地理空间映射。

结果

在 44 个设施中，6 个为 ASRH，27 个为 PSC，11 个为 CSC。百分之七十七（n = 34）属于四个医院网络之一。所有设施都使用中风评估工具；57% 完成了 LVO 筛查。在没有区域标准化的情况下，设施间转移模式存在显着异质性。17% 的 ASRH (n=1) 和 56% 的 PSC (n=15) 通过 EMS 使用地面运输进行设施间转移。60% 的非网络设施转移到最近的 CSC。在剩余的 40% 中，最近的 CSC 和选定的 CSC 之间的平均距离为 1.5 英里（最小最大 0.2-2.9 英里）。17% 的网络设施转移到最近的 CSC。在剩下的 83% 中，最近的 CSC 和选定的 CSC 之间的平均距离为 4.1 英里（最小-最大 1-8 英里）。

结论

非网络设施状态增加了转移到最近的综合卒中中心的可能性。网络设施之间的转移距离变化可能导致再灌注治疗的延迟。