Abstract Background and aims The Korean government launched the Pilot Project for the Emergency Stroke and Cardiovascular Disease Care Network in March 2024 to improve regional acute stroke care and optimize inter-hospital transfer efficiency. This study evaluated the impact of the project by comparing transfer processes and treatment patterns before and after implementation within the Geoje–Dong-A University stroke transfer network. Methods This retrospective study included consecutive stroke patients transferred from a regional hospital in Geoje—where definitive acute stroke treatment is unavailable—to the Dong-A University Regional Comprehensive Stroke Center between May 2021 and July 2025. Patients were classified into pre-implementation (May 2021–February 2024) and post-implementation (March 2024–July 2025) groups. Baseline characteristics, transfer intervals, and treatment strategies were compared, with subgroup analyses for ischemic and hemorrhagic stroke. Results Following implementation, pre-transfer hotline consultations increased substantially. Among patients with ischemic stroke, transfer efficiency improved significantly, with reductions in door-in–door-out time and door-in to final hospital door-in time. In addition, utilization of endovascular therapy and bridging therapy combining intravenous thrombolysis and intra-arterial thrombectomy increased after implementation, indicating improved access to reperfusion therapies. No significant differences in transfer times or treatment strategies were observed among patients with hemorrhagic stroke, likely due to the limited sample size. Conclusions Implementation of a regional hotline-based transfer system within the Geoje–Dong-A University network was associated with improved inter-hospital transfer efficiency and increased utilization of reperfusion therapy for acute ischemic stroke. These findings support the value of structured regional stroke networks in geographically constrained settings lacking local interventional capability. Conflict of interest Dae-Hyun Kim, Jae Gwan Cha, Jung Hwa Seo: nothing to disclose
Seo et al. (Fri,) studied this question.