Hospital-to-Hospital Transfer Delays in Hyperacute Stroke: Known Causes and Gaps in Knowledge

Abstract

Background Transfer challenges from primary stroke centers and acute stroke ready hospitals (PSC/ASRH) to a higher level of care are excessive. This narrative review examines the published literature for factors within and external to PSC/ASRH emergency departments that contribute to delays in the transfer of large vessel occlusion (LVO) patients to a higher level of care for thrombectomy.Methods A review of the literature was conducted incorporating findings from January 1996 to April 2020. Reference software was utilized to organize and track references. Retrieved papers were screened first by abstract to eliminate non-pertinent studies; papers selected for full review were then fully examined for relevance, and those retained were subsequently divided into thematic groups based on content. Results Guideline standardization of intrahospital practices and associated performance metrics, along with prehospital provider education and training have contributed to improved acute stroke service efficiency. Factors associated with transfer delays have not been identified nor quantified, yet delays contribute to significantly worse patient outcomes. Calls for bypass of lower levels of care with direct transport to CSC are fueled primarily by assumptions of poor PSC/ASRH internal performance. Conclusions Although transport delay times have been quantified as excessive, the reasons for delays are not fully understood. Additional research is warranted to fully understand why delays occur