Abstract 72: Association Between Patient and Hospital-level Factors with Door-in-door-out Times in Stroke Transfers: Findings from Get with the Guidelines®

Introduction: Advanced acute stroke treatments (endovascular therapy (EVT), neurosurgery) are time sensitive and often require emergent interfacility transfer. Thus, Door-in-door-out (DIDO) times at transferring hospitals are an important quality improvement metric. We sought to characterize DIDO times for acute stroke transfers in the Get With The Guidelines® (GWTG)-Stroke registry and identify patient and hospital factors associated with DIDO time. Methods: Patients with stroke presenting between January 2019 and December 2021 transferred from the emergency department (ED) at the presenting hospital to another acute care hospital were included. Primary outcome was DIDO time (time of transfer out minus time of arrival to presenting ED). Generalized estimating equation (GEE) regression models were used to identify patient and hospital characteristics associated with DIDO time. Subgroup analyses were performed for hemorrhagic and ischemic stroke patients transferred for EVT. Results: Among 153,434 patients (age 67.3+15.0 years, 72.9% White, 51.2% male), 107,897 were ischemic and 41,736 hemorrhagic strokes. Overall, median DIDO time was 216 (25th-75th percentile 131 - 457) minutes. The following were associated with increased DIDO time: age >80 years (+36.18 minute increase in median DIDO time), Black race (+11.23 min), Hispanic ethnicity (+9.65 min), ischemic stroke type (+156.51 min), and urban location (+44.54 min) while the following were associated with decreased DIDO time: EMS prenotification (-49.19 min) and NIHSS >12 (-139.81 min). In the EVT ischemic stroke subgroup, age, sex, race, EMS prenotification, stroke severity, and after-hours timing were strongly associated with median DIDO time. Conclusions: Opportunities to reduce DIDO times for acute stroke interhospital transfers require focus on modifiable health system factors such as EMS pre-notification but also persistent race-ethnic and urban-rural disparities.