Reducing Door-In to Door-Out Time for Patients Receiving a Mechanical Thrombectomy Using AutoLaunch Protocol

Abstract

Background

Door-in to door-out (DIDO) time for large vessel occlusion (LVO) stroke is an emerging stroke performance measure. Initial presentation at a non-Comprehensive Stroke Center (CSC) requires a transfer process that minimizes delays. Our objective was to assess whether DIDO time for stroke patients was reduced after implementation of an AutoLaunch protocol for interfacility transfers.

Methods

This was a pre-post analysis of an AutoLaunch protocol for all acute stroke patients transferred to a CSC for mechanical thrombectomy. The distribution of DIDO times between patients transferred via the AutoLaunch and traditional dispatch protocols were compared.

Results

We evaluated 92 interfacility transfers, with 22 utilizing the AutoLaunch protocol and 70 utilizing traditional dispatch. Among AutoLaunch transfers, the median DIDO time was 85 minutes (IQR: 71, 133), while the median DIDO time among the traditional transfers was 109 minutes (IQR, 84, 144) (p=0.044).

Conclusion

Implementation of an AutoLaunch protocol for patients with suspected LVO was associated with a reduction in DIDO time to CSCs. Further studies should evaluate patient outcomes based on transfer strategies.

Keywords:

• AutoLaunch
• interfacility
• transfer
• EMS
• stroke

Abbreviations

DIDO, door-in to door-out; LVO, large vessel occlusion; CSC, comprehensive stroke center; CEMS, Center for Emergency Medical Services; IFT, interfacility transfer; NSUH, North Shore University Hospital; IQR, interquartile range; DTN, door to needle.

Acknowledgments

All views expressed in the submitted article are our own and not an official position of the institution or funder.

Disclosure

Dr Jeffrey Katz reports personal fees from Medtronic, XCath, Inc; grants from Siemens Healthineers, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

There is no funding to report.