Abstract W P358: Rate of “Non-Go Activation” of a High Volume Stroke Center Neuroendovascular Team during the “After Hours”/On-Call Period: Exploring the Financial Impact to an Acute Stroke Program
Background and Purpose: Timely reperfusion in large vessel occlusion strokes (LVOS) is crucial to achieving optimal functional outcomes. Acute neurointerventional therapy requires a team of individuals be assembled and ready as soon as the workup is completed and the patient is deemed an eligible and appropriate thrombectomy candidate. On occasion, the endovascular on call team is activated but the patient is subsequently determined ineligible for interventional therapy. We aimed to explore the frequency and financial impact of on-call neuroendovascular team activation when the procedure is a “Non-Go” situation and to determine its impact on the operating budget of an acute endovascular stroke program.
Methods: From February-July 2014, information was collected on all instances of the neuroendovascular team being activated during the “After Hours”/On-Call period (defined as: weekdays 7PM-7AM and weekends e.g. Fri 7PM-Mon7AM) but a procedure not done due to patient ineligibility. The information collected included patient demographics, date and time of the activation, and reason why the procedure was not performed.
Results: During the five month data collection period, there were 12 occasions of “Non-Go Activation” of the Neuroendovascular Team during “After Hours”. Three patients (25%) were randomized to IV tPA only in a clinical trial, four patients (33%) had marked improved symptoms and/or no-occlusion on CT angiography, and five patients (42%) had large core on initial imaging. During this same period, a total of 70 thrombectomies were performed for a ratio 5.8 overall thrombectomies for every “Non-Go After Hours” activation which seems to be a financially viable model.
Conclusions: The “stand-by strategy” for the neuroendovascular team for selected stroke transfers and emergency room cases is justifiable based on the need for rapid reperfusion in LVOS. The extra burden on the “on-call” personnel is acceptable and the extra costs represent a relatively small fraction of the treatment expenses.
Author Disclosures: K.M. Schindler: None. J. Faggard: None. L. Amerson: None. S. Doppelheuer: None. L. Craft: None. A. Anderson: None. S. Belagaje: None. F. Nahab: None. R. Gershon: None. M. Frankel: None. R. Nogueira: Other Research Support; Modest; Stryker PI for TREVO-2 and DAWN trials, Penumbra Executive Committee for 3D separator trial. Other Research Support; Significant; Covidien Steering Committee for the SWIFT and SWIFT PRIME sudies and core lab for the STAR trial.
- © 2015 by American Heart Association, Inc.