Abstract Details

Title The Neuroemergencies Management and Transfers (NEMAT) Program: A System of Care to Improve Outcomes for Patients Transferred for Neurological Emergencies

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P14 - Poster Session 14 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-018

Objective To describe the impact of a novel centralized, coordinated system of care for interhospital transfer of patients with neuroemergencies in reducing transfer times and improving access to definitive care.

Background Patients with neuroemergencies often undergo interhospital transfer to tertiary hospitals with specialized neurocritical care units and advanced surgical capabilities (e.g. thrombectomy, hematoma evacuation). However, obstacles such as miscommunication between referring and accepting providers, lack of standardized treatment and transfer protocols, insurance verification delays, limited critical care beds, and others increase transfer times and result in poor outcomes. The American Heart Association Guidelines for Stroke Systems of Care cite pre-hospital communication and emergent triage protocols as essential for improving outcomes in time-sensitive neuroemergencies.

Design/Methods In May 2017, we implemented the NEMAT program to protocolize care and interhospital transfers for neuroemergencies in our health system. NEMAT includes an interdisciplinary provider team, a centralized system-wide transfer center, practice guidelines for emergent triage, transfer, and management, closed-loop disease- and hospital-specific communication channels, and a quality assurance database. Disease frequency, transfer volume, and transfer times were analyzed. Interhospital transfer times for neuroemergencies after NEMAT implementation (5/2017-9/2019) were compared to those from 2008-2015, and results were stratified by disease subtype. Wilcoxon-Mann-Whitney tests were performed to determine the difference in transfer times across time periods.

Results During the pre-NEMAT period, there were 1677 transfer patients.12.5% were ELVO, 16.9% were SAH, and 14.2% were ICH. There were 1650 transfers during the post-NEMAT implementation period; the top three disease types were ELVO (24.8%), SAH (11.8%), and ICH (8.7%). Transfer times significantly decreased overall and by disease type from pre-NEMAT to post-NEMAT implementation (p≤0.0001).

Conclusions NEMAT implementation reduced interhospital transfer times for patients presenting with neurological emergencies compared to the pre-NEMAT period. Comprehensive systems of care that integrate triage, management, and transfer are promising tools for reducing inefficiencies in acute management of neuroemergencies.

Authors/Disclosures
Neha Dangayach, MD, F�鶹��ýӳ�� (Icahn School of Medicine At Mount Sinai and Mount Sinai Hospital) PRESENTER	Dr. Dangayach has nothing to disclose.
Ian Cossentino, BS (Icahn School of Medicine at Mount Sinai)	No disclosure on file
	No disclosure on file
	No disclosure on file
Natalia Romano Spica	Ms. Romano Spica has nothing to disclose.
	No disclosure on file
	No disclosure on file
John Liang, MD (Mount Sinai Health System)	Dr. Liang has nothing to disclose.
Kaitlin Reilly-Kit, MD (Hackensack University Medical Center)	Dr. Reilly-Kit has nothing to disclose.
Alexandra S. Reynolds, MD	Dr. Reynolds has nothing to disclose.
	No disclosure on file
Christopher P. Kellner, MD (Mount Sinai Health System)	Dr. Kellner has stock in METIS Innovative. Dr. Kellner has stock in Precision Recovery. Dr. Kellner has stock in Synchron. Dr. Kellner has stock in Fluid BioMed. Dr. Kellner has stock in Proprio. Dr. Kellner has stock in Von Vascular. Dr. Kellner has stock in E8. Dr. Kellner has stock in Borvo. Dr. Kellner has stock in Phantom Neuro. Dr. Kellner has stock in Radical. Dr. Kellner has stock in Reach Neuro. Dr. Kellner has stock in Aurenar. The institution of Dr. Kellner has received research support from Integra. The institution of Dr. Kellner has received research support from Penumbra. The institution of Dr. Kellner has received research support from Viz.AI. The institution of Dr. Kellner has received research support from ICE Neurosystems. The institution of Dr. Kellner has received research support from Irras. The institution of Dr. Kellner has received research support from Microtransponder. The institution of Dr. Kellner has received research support from Medtronic. The institution of Dr. Kellner has received research support from Longeviti. The institution of Dr. Kellner has received research support from Endostream. The institution of Dr. Kellner has received research support from CVAID.
Johanna T. Fifi, MD, F�鶹��ýӳ�� (Mount Sinai Hospital)	Dr. Fifi has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Stryker, Inc. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Dr. Fifi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Fifi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Serenity. Dr. Fifi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MIVI. Dr. Fifi has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. Dr. Fifi has stock in Endostream. Dr. Fifi has stock in Synchron. Dr. Fifi has stock in Imperative Care. Dr. Fifi has stock in Truvic. Dr. Fifi has stock in Bendit. Dr. Fifi has stock in Cerebrotech. Dr. Fifi has stock in Sim&Cure. Dr. Fifi has stock in Q'Apel. The institution of Dr. Fifi has received research support from Viz AI.
Errol L. Gordon, MD (Neurology & Stroke)	No disclosure on file
Stanley Tuhrim, MD (Mount Sinai Medical Center)	No disclosure on file
	No disclosure on file
Neha Dangayach, MD, F�鶹��ýӳ�� (Icahn School of Medicine At Mount Sinai and Mount Sinai Hospital)	Dr. Dangayach has nothing to disclose.

�鶹��ýӳ��

�鶹��ýӳ��