Abstract 3091: Image Sharing Prior To Transfer Of Patients With Stroke
Introduction: The lack of 24X7 availability of sub-specialty neurologists and neurosurgeons in regional county hospitals frequently leads to transfer of patients with stroke/ICH to higher tertiary care centers. Transfer of patients without prior communication may delay both diagnosis as well as time sensitive treatments. Recently our institution adopted image sharing prior to transfer to facilitate triage of inter-hospital transfers.
Aim: To analyze if image sharing enabled judicious selection of patients more likely to require intensive care/intervention.
Methods: We analyzed consecutive adult patients with an admission diagnosis of stroke/TIA/carotid stenosis/carotid-dissection/aneursym/hemiplegia/cerebral venous sinus thrombosis for whom an interhospital transfer request was made.
Results: The cohort had 197 subjects with 52.6% females. The mean age of subjects was 61.1 years (SD 16.1 years). The mean distance of healthcare facilities requesting transfer from our center was 47.7 miles (SD 28.5 miles). Of all transfer requests, 78.7% (155) were accepted to our facility, 14.7% (29) were asked to follow up in outpatient clinics, 3% (6) transfers were cancelled because a higher level of care was deemed unnecessary, 1% (2) patients declined transfer and 2.5% (5) were lost to other facilities. The median stroke severity measured by NIHSS on arrival was 3 (IQR 1 to 8). Images were shared prior to decision making for transfer for 20.3% (40) patients. Fewer patients were accepted for transfer with image sharing (73%) than without (83.7%), although this did not reach statistical significance (z statistic -1.51; p=0.132). There was no significant difference in NIHSS (p=0.3919), neurological status measured by GCS (p=0.294) or age (p=0.9942) between subjects who had image sharing versus those who did not. Amongst all accepted patients 45.1% were deemed to need intensive care and 47.7% received interventions (surgical, medical or advanced diagnostic testing). The proportion of patients who underwent intervention or were admitted to an intensive care unit was much higher when patients’ images were shared prior to transfer (85.2%) when compared to patients transferred without image sharing (56.8%; z statistic 2.755; p=0.006). The odds of undergoing intervention when patients were transferred after image sharing was 4.37 as compared to patients transferred without image sharing (95% CI 1.43 to 13.39).
Conclusion: Subjects who had their images shared prior to transfer had significantly higher intervention rate. Thus image sharing is a possible tool to increase specificity for selecting patients with stroke related diagnoses, who would benefit from transfer to a tertiary care center.
- Cerebrovascular disorders
- Health services research
- Healthcare delivery systems
- Emergency care
- © 2012 by American Heart Association, Inc.