Americans experiencing strokes are waiting longer for optimal care, despite the critical importance of time in preserving brain function.

Americans experiencing strokes are waiting longer for optimal care, despite the critical importance of time in preserving brain function.

Americans Facing Delays in Stroke Care Transfers

When it comes to stroke care, time is of the essence. However, a recent study published in the Journal of the American Medical Association reveals that most Americans experiencing a stroke face delays in transferring to another hospital that can provide advanced stroke care. This delay is a serious concern, as experts emphasize the importance of swift action to prevent further damage and increase the chances of recovery.

The study examined the “door-in, door-out” times in stroke care, which measure the duration from a patient’s arrival in the emergency department (ED) to their transfer to a hospital equipped for advanced stroke treatment. The results were concerning, with approximately 73% of stroke patients in the United States waiting for over two hours, surpassing the recommended goal for stroke transfers.

Although the study couldn’t pinpoint the exact reasons behind the delays, senior researcher Dr. Shyam Prabhakaran, a professor of neurology at the University of Chicago Medicine, suggested several potential bottlenecks that lead to these prolonged wait times. Patients may experience delays in evaluation upon arrival in the ED, accessing a CT scanner or other necessary imaging for stroke diagnosis, finding a hospital willing to accept the patient, or arranging transportation.

Furthermore, the study highlighted disparities in wait times among different groups of patients. Women generally experienced longer wait times than men, and Black and Hispanic patients faced more extended delays compared to their white counterparts. These findings are disappointing and mirror existing disparities in various areas of medical care.

Dr. Prabhakaran emphasized the importance of addressing these issues, urging healthcare systems to improve stroke transfer efficiency. The study’s findings provide crucial information that can be leveraged for future quality-improvement programs to reduce overall door-in, door-out times and eliminate disparities in stroke care.

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Dr. Michael Mullen, the director of the stroke program at Temple University Hospital, considered the study’s findings significant and pointed out key takeaways for the general public. Patients who arrived at the ED by ambulance and had paramedics notify the hospital about a suspected stroke were typically transferred faster. This observation underscores the importance of promptly calling 911 when experiencing stroke symptoms rather than trying to reach the ED independently.

Strokes occur when blood flow to the brain is suddenly disrupted, resulting in symptoms such as weakness or numbness in the face, arm, or leg, difficulty speaking, confusion, or difficulty walking. Most strokes are ischemic, caused by a blood clot in an artery supplying the brain. In such cases, hospitals can provide intravenous medication to break up the clot. However, patients often require transfer to a different hospital that can offer advanced treatments, including surgical procedures. This applies to hemorrhagic strokes as well, which result from a ruptured vessel bleeding into the brain.

This study is the first to examine door-in, door-out times on a national scale, shedding light on the extent of the problem. Unfortunately, the findings are worse than expected. The researchers analyzed data from a national database maintained by the American Heart Association (AHA) and involving nearly 109,000 stroke patients transferred from 1,925 participating hospitals between 2019 and 2021.

The study revealed that almost three-quarters of patients had to wait over two hours from their arrival at the initial hospital until their departure for transfer, not including travel time to the next hospital. The median wait time for all patients was around three hours, with women, Black, and Hispanic patients experiencing delays of an additional 5 to 8 minutes compared to men and white patients.

Dr. Prabhakaran echoed the importance of the “time is brain” message for the general public, emphasizing the need to call 911 immediately during a stroke. However, he also stressed the significance of ensuring a streamlined process after the 911 call. To address this, Dr. Prabhakaran and his colleagues are conducting a clinical trial to test different strategies for reducing door-in, door-out times. They aim to help smaller hospitals efficiently evaluate stroke patients and expedite the transfer process.

This study serves as a clarion call to healthcare systems, encouraging them to improve stroke care by minimizing delays in transfers. The findings underscore the critical need for efficient and coordinated systems that prioritize timely intervention and minimize disparities in stroke treatment.

Key Takeaways:

• Most Americans experiencing a stroke face delays in transferring to hospitals equipped for advanced stroke care.
• Patients wait for over two hours, surpassing the recommended goal for stroke transfers.
• Various reasons contribute to these delays, including evaluation wait times, accessing necessary imaging, finding accepting hospitals, and arranging transportation.
• Disparities exist, with women, Black, and Hispanic patients experiencing longer wait times.
• Promptly calling 911 during a stroke is crucial, as ambulance arrivals often lead to faster transfers.
• Strokes occur due to interrupted blood flow in the brain, necessitating advanced treatments.
• Healthcare systems must focus on improving stroke transfer efficiency to reduce disparities.
• Further research and quality-improvement programs are vital to streamline the door-in, door-out process, benefiting all stroke patients.