Description: Median time from hospital arrival in the emergency department to transfer of a hemorrhagic stroke patient or an ischemic stroke patient to another hospital.
Rationale: Hemorrhagic stroke is a life-threatening condition caused by a rupture in a weakened blood vessel in the brain. Surgical intervention to repair a ruptured aneurysm may be indicated and necessitate urgent transfer of the patient, if the hospital is unable to provide advanced neurological treatments and services.
The benefits of both IV altelplase and mechanical thrombectomy for the treatment of acute ischemic stroke are time dependent. The earlier the treatment within the time window, the greater the benefit to patients. Initiation of IV alteplase at a primary stroke center (PSC) and rapid transport to an advanced center capable of performing endovascular treatment may lead to faster and more complete reperfusion for certain patients eligible for these treatments (Powers, 2018).
The Brain Attack Coalition recommends that such transfers occur within 2 hours of patient arrival at the transferring stroke center (Alberts, 2013). Reducing the time stroke patients remain in the emergency department (ED) can improve access to a higher-level of stroke care and surgical intervention or advanced intra-arterial endovascular treatments, and increase quality of care. For those stroke patients who are not transferred to a TSC or CSC, inpatient admission within 3 hours, preferably to a formal stroke unit, is recommended (Jauch, 2013).