Transferring Patients From a Primary Stroke Center to Higher Levels of Care: A Qualitative Study of Stroke Coordinators' Experiences

Background: Transfer times from primary stroke centers and acute stroke-ready hospitals to higher levels of care are often excessive, prompting some to suggest ambulance bypass regulations. Since barriers to rapid transfer have never been fully explored, we sought to understand stroke coordinators' experiences with transfer of patients with hyperacute stroke from lower to higher levels of stroke centers. Methods: We conducted a national focus group study with primary stroke center stroke coordinators who had recent experience overseeing transfer of a patient with hyperacute stroke to a higher-level stroke center. Interviews were conducted using prescripted open-ended questions; information was recorded and data were transcribed for theme identification. Results: A total of 23 stroke coordinators participated representing the Northeast, Mid-Atlantic, Southeast, Midwest, and Western United States. Findings were grouped into 3 main categories: Internal Primary Stroke Center Factors, Transport Factors, and External Comprehensive Stroke Center Factors. Within the primary stroke center group, themes slowing transfer were exclusively physician based, whereas themes emerging from the transport category were associated with poor transport company processes. Within the comprehensive stroke center category, themes were all associated with complex hospital processes and communication. Conclusion: Important contributors to efficient transfer of patients with hyperacute stroke are beyond the control of stroke coordinators, requiring cross-system collaboration and improved administrative management to resolve. Quantification of these factors is warranted to support transfer system redesign for rapid access to care for patients with stroke.