The study was conducted at a PSH located 43 km from a CSC in Icheon, Gyeonggi-do, South Korea in 2020, which included approximately 230,000 residents. Since 2019, the PSH has renovated its stroke care system to set up a clinical pathway (CP) with a focus on IVT in the emergency room and provide key stroke treatment in the newly operating stroke unit. It also created a direct transfer system with the CSC, which aimed to succeed in conducting EVT and supporting any other stroke treatments that occurred in the PSH (Fig. 1 ). Based on the formal agreements, a hotline telephone line, transfer protocol, and feedback system were established.
The CP in the PSH permitted flexible imaging modalities according to the expertise and decisions of the attending physicians. It conducted CT protocol with a high priority and set up MRI protocol by the physicians’ decision. In both processes, they consisted of multiphasic CT angiography and CT perfusion or diffusion-weighted imaging and MR angiography. When the attending physician wanted, it also allowed to perform the non-contrast CT protocol and transfer with the consultation. When any decisions on IVT, post-IVT management, EVT, neurosurgery or intensive care, or other related matters were required, direct contact was initiated with a stroke neurologist at the CSC and subsequent steps in both hospitals were decided. Using the hotline system, physicians directly discuss each clinical vignette and appropriate therapeutic plans, including a rapid transfer, immediate treatment at PSH, and posttransfer treatment.
This retrospective study identified a consecutive series of patients with stroke transferred between March 2019 and January 2020. By reviewing the electronic medical records and stroke registry, we collected data on age; sex; stroke risk factors such as hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, current smoking, and baseline National Institutes of Health Stroke Scale (NIHSS) score; stroke onset time; and acute revascularization therapies for IVT and EVT. We also surveyed the time indicators of door-in (arrival at PSH), imaging, transfer decision, and door-out (departure from PSH) of the PSH, and transportation, arrival at CSC, and acute treatment times at the CSC. In IVT and EVT cases, the door-in times of the PSH to needle (DTN) and puncture (DTP) were calculated.
The CP in the PSH permitted flexible imaging modalities according to the expertise and decisions of the attending physicians. It conducted CT protocol with a high priority and set up MRI protocol by the physicians’ decision. In both processes, they consisted of multiphasic CT angiography and CT perfusion or diffusion-weighted imaging and MR angiography. When the attending physician wanted, it also allowed to perform the non-contrast CT protocol and transfer with the consultation. When any decisions on IVT, post-IVT management, EVT, neurosurgery or intensive care, or other related matters were required, direct contact was initiated with a stroke neurologist at the CSC and subsequent steps in both hospitals were decided. Using the hotline system, physicians directly discuss each clinical vignette and appropriate therapeutic plans, including a rapid transfer, immediate treatment at PSH, and posttransfer treatment.
This retrospective study identified a consecutive series of patients with stroke transferred between March 2019 and January 2020. By reviewing the electronic medical records and stroke registry, we collected data on age; sex; stroke risk factors such as hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, current smoking, and baseline National Institutes of Health Stroke Scale (NIHSS) score; stroke onset time; and acute revascularization therapies for IVT and EVT. We also surveyed the time indicators of door-in (arrival at PSH), imaging, transfer decision, and door-out (departure from PSH) of the PSH, and transportation, arrival at CSC, and acute treatment times at the CSC. In IVT and EVT cases, the door-in times of the PSH to needle (DTN) and puncture (DTP) were calculated.
