Background: The John Hunter Hospital (JHH) is the comprehensive stroke centre (CSC) providing endovascular clot retrieval (ECR) throughout northern New South Wales. The diagnosis, referral, transfer, and treatment requires a coordinated effort by several teams to minimise treatment delays. Transfers supported by air retrieval services can be lengthy and improvements in time metrics for this increasing proportion of CSC ECR referrals is likely to have a significant impact on patient outcomes. This study looked to define and measure key time metrics from diagnosis to treatment.
Methods: A retrospective analysis of transfers to JHH for ECR by the air retrieval service demonstrated key time point metrics: CT scan time at the referring hospital, State-wide Telestroke Services (TSS) referral time to the CSC for ECR, air retrieval tasking time, laboratory arrival time and groin puncture time. The TICI score and 90-day mRS were also recorded.
Results: The mean CT to TSS referral time was 33 minutes (IQR 27-38.5), the mean CT to air retrieval tasking time was 88 minutes (IQR 70.5-105), the mean air retrieval tasking to laboratory arrival time was 178 minutes (IQR 140-206) and the mean laboratory arrival to groin puncture time was 29.5 minutes (IQR 23-35). The mean mRS was 3 if treated within 4.5 hours post-CT and 4 if treated later.
Discussion: There appear to be four main time metrics identified as targets for reducing ECR treatment delays in long-distance transferred patients. This serves as a benchmark for prospective assessment of system changes, aimed at reducing treatment delays.