A 64-year-old female patient presents to the emergency department of our suburban community hospital with acute confusion, aphasia, and right sided facial droop. Code stroke called. Labs drawn. Telestroke initiated. Imaging shows large vessel occlusion (LVO).
Though the diagnosis is not difficult to make, the dilemma we face—and that many hospitals face at this point—is how to optimize management. In this case, three hospitals downtown can perform endovascular thrombectomy. It is time to transfer. However, this patient’s transfer takes much longer than it should, when every minute matters.