For LVO stroke patients, the DIDO reflects the time from arrival at a non-thrombectomy-capable hospital until their transfer out to a thrombectomy-capable hospital. It is recommended that DIDO times not exceed 90 minutes, however, the average DIDO time in US hospitals in 2023 was 174 minutes.

Our hospital system consists of seven spokes and two hubs which perform thrombectomy. LVO patients presenting to our spoke hospitals are evaluated, treated, and triaged via telestroke by a stroke team. We implemented a protocol driven, regional LVO transfer model on 8/28/2023.

Pre-implementation, the transfer process was initiated and driven by each spoke hospital on a case-by-case basis in coordination with the system operations center (SOC). Examples of key changes post-implementation included: 1) assigning one hub hospital to be the primary transfer destination for each spoke hospital, 2) the SOC was no longer required to confirm the availability of a post-procedure inpatient bed before transfer, and 3) assigning transfer coordination tasks to specific providers and support staff roles.

We retrospectively reviewed all LVO patients who were transferred for thrombectomy between 1/8/2022 and 8/14/2024. We utilized the Wilcoxon rank-sum test to assess DIDO times pre- and post-implementation.