Introduction: Stroke care within a Comprehensive Stroke Center (CSC) has had long-standing emphasis on protocolized, high-stakes ischemic stroke care. Certified centers are required to have stroke coordinators to facilitate care delivery, oversee quality and monitor compliance. Arguably, hemorrhagic stroke lacks the same dedicated oversight. A recent “Call to Action” from the AHA advocated for adoption of early bundle of care, with focus on time-based metrics. A large academic CSC in Maryland identified disparities in intracerebral hemorrhage (ICH) stroke quality metrics, documentation, and care coordination compared to ischemic stroke. A retrospective analysis was conducted to identify process opportunities for ICH management, compared to the ischemic stroke population. Methods: A comprehensive ICH and thrombectomy database, maintained by the CSC data analyst was queried from July 2023 to July 2024. Key time metrics were compared between the two groups including: time from first call by the primary stroke center (PSC) to acceptance by the comprehensive stroke center (CSC), door-in-door-out (DIDO), CSC acceptance-to-dispatch, dispatch-to-en route, and acceptance-to-patient arrival. Results: A total of 46 ICH patients and 87 AIS patients were analyzed for First Call to Acceptance. ICH patients showed shorter mean times compared to AIS patients (22 mins vs. 36 mins). For DIDO, data from 39 ICH patients and 66 AIS patients were analyzed; ICH patients had longer mean times (213 mins vs. 166 mins). Acceptance to Dispatch, 45 ICH and 85 AIS patients were included, with ICH patients showing longer mean times (43.5 mins vs. 15 mins). For Dispatch to En Route, 45 ICH and 85 AIS patients were analyzed, revealing longer mean times for ICH patients (33 mins vs. 9 mins). For Acceptance to Arrival, 44 ICH and 87 AIS patients were included, with ICH patients experiencing longer mean times (160 mins vs. 105 mins) Conclusion: Significant disparities in time-sensitive metrics were observed between ICH and AIS patients, underscoring the gap in care coordination for ICH patients. In response, the creation of a dedicated hemorrhagic stroke coordinator position was the first critical step to improve quality, compliance and timeliness of care. Mirroring the established role of ischemic stroke coordinators, this role should be considered as best practice for CSCs committed to delivering high-quality, equitable stroke care across all stroke subtypes.
Davies et al. (Thu,) studied this question.