Central Triage of Acute Stroke Patients Across a Distributive Stroke Network Is Safe and Reduces Transfer Denials.
Central Triage of Acute Stroke Patients Across a Distributive Stroke Network Is Safe and Reduces Transfer Denials.
复制标题
DOI：
10.1161/strokeaha.120.033018
复制
发表时间：
2021-08
期刊：
影响因子：
8.3
通讯作者：
Ford AL
中科院分区：
文献类型：
--
作者：
Holder D;Leeseberg K;Giles JA;Lee JM;Namazie S;Ford AL
Mechanical thrombectomy has dramatically increased patient volumes transferred to comprehensive stroke centers (CSC), 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. 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- vs. post-DSN implementation. Safety outcomes and rate of CSC transfer denials were compared pre-DSN vs. post-DSN. The pre-DSN cohort (N=150), triaged to the CSC, had a similar rate of symptomatic intracerebral hemorrhage and discharge location compared to the post-DSN cohort (N=150), triaged to the PSC. Time-to-stroke unit admission was faster post-DSN (2h 40min) vs. pre-DSN (3h 29min), P<0.001. Transfer denials were reduced post-DSN (1.8%) vs. pre-DSN (3.8%, P=0.02), despite an increase in telestroke consultation volume over the same period (median 3 calls per day pre-DSN vs. 5 calls per day post-DSN, P=0.001). No patients who were triaged to the PSC required subsequent transfer to the CSC. 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.
