Abstract Details

Title Reducing Unnecessary Hospital Transfers for Patients Not Taken for Thrombectomy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-008

Objective

To assess the reasons why patients transferred for consideration of mechanical thrombectomy (MT) do not receive the procedure.

Background Access to MT for qualifying individuals is essential, however there are downsides for both patients and the healthcare system when patients are transferred unnecessarily. Our previous work several years ago determined that 39% of patients transferred for possible MT based on clinical criteria and CT only did not have a large vessel occlusion (LVO). This led to a health system wide guideline to improve transfer selection by adding criteria for emergent CT angiography (CTA). This study aims to analyze the current reasons why patients transferred for consideration of MT don’t receive the procedure.

Design/Methods All patients transferred for consideration of MT for acute stroke between January 1^st, 2019 and June 30^th, 2021 for whom MT was not attempted were chart reviewed for the reason MT was not pursued.

Results During the 30 months reviewed, 316 patients were transferred for consideration of MT and were not taken for the procedure. The top reasons for this were absence of LVO on vessel imaging (26.3%), lack of suspicion of LVO on clinical assessment (18.0%), infarct size that was too large on perfusion imaging (13.3%), and improvement in symptoms (12.0%). Other reasons included ASPECT score, lack of perfusion mismatch, and poor baseline, among others.

Conclusions Despite a system-wide protocol and widespread availability of CTA, the biggest reason for transferred patients not proceeding to MT remains a lack of LVO. Consequences of unnecessarily transferring patients include increased cost, moving patients farther away from their home and family, and non-essential use of tertiary hospital bed space. Given the prevalence of potentially preventable unnecessary transfers, protocols that support in-the-field triage and transport based on clinical criteria alone will worsen health system efficiency and decrease value for patients with acute ischemic stroke.

Authors/Disclosures
Kelsey Duncan, MD PRESENTER	Dr. Duncan has nothing to disclose.
	No disclosure on file
	No disclosure on file
Cathy A. Sila, MD, FAAN (Neurological Institute Cleveland Medical Center)	Dr. Sila has nothing to disclose.

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