We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Emergency Department Process Times and Door-In–Door-Out Times in Interhospital Transfers After Acute Ischemic Stroke.
- Authors
Royan, Regina; Stamm, Brian; Giurcanu, Mihai; Messe, Steven R.; Jauch, Edward C.; Prabhakaran, Shyam
- Abstract
Key Points: Question: What are the key process steps in the care of patients with acute ischemic stroke (AIS) that contribute to the duration of time spent at transferring hospitals? Findings: This retrospective cohort study of a national, hospital-based registry included 28 887 patients with AIS. Imaging-to-door time contributed more to overall door-in–door-out time than other components of emergency care at transferring hospitals. Meaning: To improve the timeliness of interhospital transfer of patients with AIS, quality improvement efforts and care guidelines should focus on process steps that occur after imaging. Importance: Stroke treatment is exquisitely time sensitive. The door-in–door-out (DIDO) time, defined as the total time spent in the emergency department (ED) at a transferring hospital, is an important quality metric for the care of acute stroke. However, little is known about the contributions of specific process steps to delays and disparities in DIDO time. Objective: To quantify process steps and their association with DIDO times at transferring hospitals among patients with acute ischemic stroke (AIS). Design, Setting, and Participants: This retrospective cohort study analyzed patients in the American Heart Association Get With the Guidelines–Stroke registry with AIS presenting between January 1, 2019, to December 31, 2021, and transferred from the presenting hospital ED to another acute care hospital for evaluation of thrombolytics, endovascular therapy, or postthrombolytic care. Data were analyzed from July 8 to October 13, 2023. Exposures: Intervals of ED care of ischemic stroke: door-to-imaging and imaging-to-door times. Main Outcomes and Measures: The primary outcome was DIDO time. Multivariate generalized estimating equations regression models were performed to compare contributions of interval process times to explain variation in DIDO time, controlling for patient- and hospital-level characteristics. Results: Among 28 887 patients (50.5% male; mean [SD] age, 68.3 [14.8] years; 5.5% Hispanic, 14.7% non-Hispanic Black, and 73.2% non-Hispanic White), mean (SD) DIDO time was 171.4 (149.5) minutes, mean (SD) door-to-imaging time was 18.3 (34.1) minutes, and mean (SD) imaging-to-door time was 153.1 (141.5) minutes. In the model adjusting for door-to-imaging time, the following were associated with longer DIDO time: age 80 years or older (compared with 18-59 years; 5.97 [95% CI, 1.02-10.92] minutes), female sex (5.21 [95% CI, 1.55-8.87] minutes), and non-Hispanic Black race (compared with non-Hispanic White 10.09 [95% CI, 4.21-15.96] minutes). In the model including imaging-to-door time as a covariate, disparities in DIDO by age and female sex became nonsignificant, and the disparity by Black race was attenuated (2.32 [95% CI, 1.09-3.56] minutes). Conclusions and Relevance: In this national cohort study of interhospital transfer of patients with AIS, delays in DIDO time by Black race, older age (≥80 years), and female sex were largely explained by the imaging-to-door period, suggesting that future systems interventions should target this interval to reduce these disparities. While existing guidelines and care resources heavily focus on reducing door-to-imaging times, further attention is warranted to reduce imaging-to-door times in the management of patients with AIS who require interhospital transfer. This cohort study quantifies the length of time to complete process steps in the initial care of patients with acute ischemic stroke and determines which process steps account for most disparities by sex, race and ethnicity, and age in door-in–door-out times for interhospital transfer.
- Subjects
UNITED States; PATIENTS; RESEARCH funding; HOSPITAL admission &; discharge; HUMAN beings; HOSPITAL emergency services; RETROSPECTIVE studies; DESCRIPTIVE statistics; LONGITUDINAL method; ISCHEMIC stroke; MEDICAL records; ACQUISITION of data; CONFIDENCE intervals; DATA analysis software; TIME; REGRESSION analysis
- Publication
JAMA Network Open, 2024, Vol 7, Issue 9, pe2431183
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.31183