A recent study conducted by the University of Chicago Medical Center shows that almost three-quarters of acute stroke patients wait two hours or more to be transferred from a smaller hospital that doesn’t provide stroke services to a comprehensive stroke center. This delay can be deadly or result in a long-term disability or severe harm because there is a small window of time in which life-saving drugs and treatments can be administered.
The senior author of the study, Shyam Prabhakaran, MD, MS James Nelson, and Anna Louise Raymond Professor and Chair of the Department of Neurology at the University of Chicago, said that “In neurology, we often say that ‘time is brain.’ For every 15 minutes that pass without treatment, prior research shows there is a steady decrease in the chances of good outcomes for stroke patients. Getting to the right hospital quickly can be lifesaving.”
The University of Chicago Medical Center analyzed data from 1,925 hospitals and more than 100,000 patients across America. The researchers reported that the median time (the middle when all the times are stacked from high to low) between “initial arrival and departure for transfer, known as door-in-door-out (DIDO) time, was 174 minutes.”
Nearly three-quarters of the patients waited longer than 120 minutes, which is considered the maximum recommended wait time – the time beyond which life-saving medications and procedures are more likely to work. The DIDO doesn’t even include the additional “transport time between hospitals.” When this additional transfer time is added to the DIDO time, patients may not be able to receive medications/interventions such as a thrombectomy to remove blood clots causing the stroke.
Types of stroke care
The CDC states that time is critical for victims of ischemic stroke. Patients who get to the hospital within three hours of the onset of ischemic stroke symptoms may be given a life-saving medication called tissue plasminogen activator (tPA) which is a thrombolytic (clot-busting) drug. Patients who receive tPA are generally more likely to survive an ischemic stroke and have less disability than patients who don’t receive the drug. Other medications such as blood thinners may be effective. A two to three hour delay can easily mean that a stroke victim can’t receive the medications and treatments that could save his/her life or prevent serious complications from occurring.
Patients who have a hemorrhagic stroke may require surgery, medicines, and other procedures to stop the brain from bleeding and save the patient’s brain tissue. Medical procedures may include surgery. For example, a metal clip may be inserted to stop blood loss due to a ruptured aneurysm and endovascular procedures to repair “a weak spot or break in a blood vessel.”
The patients who were likely to have the highest DIDO times included the elderly, Black people, Hispanics, and females. While variations in disease presentation could contribute to the time differences, Prabhakaran said the results of the study indicate that there needs to be a “greater focus on health equity when it comes to stroke care.” Dr. Prabhakaran emphasized that if you’re having a stroke, your gender, race, or ethnicity should not affect the outcome – you should receive the same quality and timeliness of care. The doctor urged both healthcare providers and policymakers alike to be “vigilant against and combat systemic biases that exist in healthcare.”
Why long wait times to arrange stroke transports are occurring
Doctor Prabhakaran explained that the DIDO times are much too high for everyone. He emphasized that healthcare hospitals and providers need to bring the times down so stroke victims can receive timely and quality care. He discussed one of the factors that are contributing to the increased wait times (in addition to bias concerns). Calling ahead to notify medical centers that patients who had stroke systems were on their way by ambulance or some other transport service reduced DIDO times by 20 minutes. He added that calling 911 does have immediate benefits for initially stabilizing a patient and for the subsequent care the patient receives.
Dr. Prabhakaran and his research team are now leading an NIH-funded study called the “Hospital Implementation of a Stroke Protocol for Emergency Evaluation and Disposition” study. This study is a “multi-center cluster randomized clinical trial” whose aim is to examine and test policies and procedures that can help reduce DIDO times and improve the functional outcomes of patients suffering from acute strokes who require inter-hospital transfer. Inter-hospital transfers occur when smaller hospitals don’t have the medical resources to help stroke patients – so they arrange transfers to larger hospitals that can provide acute stroke care.
The NIH study aims to identify best practices for improving stroke care in diverse regions of America.
Dr. Prabhakaran’s study is called – “Patient and Hospital-Level Factors Associated with Door-In-Door-Out Times for Inter-Hospital Transfer of Patients with Stroke.” The study was published in JAMA in August 2023.
Do stroke care victims have the right to file a personal injury claim?
Hospitals, nursing homes, assisted living facilities, and private caretakers should know the signs that someone is having a stroke and the procedures for obtaining prompt help for a stroke victim. Time is of the essence.
When the people and businesses (such as nursing homes) who have a duty to recognize stroke symptoms fail to follow best practices for responding to strokes including arranging for immediate medical transport and contacting the resident’s doctor, the people and businesses can be held liable for any complications or losses arising from delayed stroke care.
If a senior or someone who cares for a senior suffered a preventable or treatable stroke, the elder abuse attorneys at Garcia & Artigliere are ready to answer your questions and assert your right to compensation. Our elder care lawyers will guide you through each step of the legal process. Contact our firm to schedule a free and confidential consultation today. We have offices in Long Beach, Los Angeles, Louisville, Phoenix, and New Orleans.
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Stephen M. Garcia represents victims of elder and nursing home abuse and is known as one of the leading civil litigators in the country. He is Senior Partner at Garcia & Artigliere, where the firm’s practice is focused on elder abuse, nursing home abuse, and wrongful death of the elderly.
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