{
  "abstract": "Background Time from last known normal (LKN) to thrombectomy is a major determinant of functional outcome in acute ischemic stroke. Rapid transfer to thrombectomy-capable centers is therefore a national priority. Door-in door-out (DIDO) time reflects the duration a patient remains at the transferring facility prior to departure, with current guidelines targeting DIDO <90 minutes in at least 50% of transferred patients. We evaluated DIDO performance and its key contributors across referring hospitals within our regional stroke network.Methods A retrospective analysis of patients transferred to a Comprehensive Stroke Center was conducted between September 2020 and May 2025. Stroke workflow metrics were obtained using the Viz.ai platform. Referring Primary Stroke Centers (PSCs) were categorized by transfer volume, whereas all Acute Stroke-Ready Hospitals (ASRHs) were analyzed as a single group. Nonparametric variables were compared using Mann-Whitney U and Kruskal-Wallis tests, and data are reported as median (interquartile range). Correlations were assessed using Spearman’s rho. Statistical analyses were performed using Excel and SPSS version 29.Results A total of 314 transferred patients from five PSCs and 15 ASRHs were included. Median DIDO time was 108 minutes (IQR 63). PSCs demonstrated significantly shorter DIDO times compared with ASRHs and across most workflow intervals, except for the transfer decision-to-door-out interval. This interval represented the longest component of DIDO across both facility types and showed a strong positive correlation with total DIDO time (ρ = 0.84, p < 0.001). The most geographically distant PSC (PSC 2) exhibited significantly longer DIDO and decision-to-door-out intervals compared with other PSCs (p < 0.001 for both). When stratified by distance from the Comprehensive Stroke Center (<70 miles vs ≥70 miles), air transport was associated with shorter decision-to-door-out times in hospitals located ≥70 miles away [median (IQR): 70 (39) vs 111 (102) minutes; p = 0.003) but longer times in hospitals located <70 miles [69.5 (27) vs 49.5 (31) minutes; p < 0.001) compared to ground EMS.Conclusion The transfer decision-to-door-out interval is the primary contributor to prolonged DIDO in interhospital stroke transfer and a key target for process improvement; notably, air transport is associated with shorter decision-to-door-out times at distances ≥70 miles but longer times at <70 miles compared with ground EMS.Disclosures H. Abdelhamid: None. J. Frank: None. J. Lee: None. L. Wise: None. L. Perkins: None. M. Al-Kawaz: None. D. Dornbos III: None. S. Sizdahkhani: None. J. Fraser: None.Abstract E-143 Table 1",
  "authors": [
    {
      "affiliations": [
        "Neurology, University of Kentucky, Lexington, KY"
      ],
      "name": "H Abdelhamid"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kentucky, Lexington, KY"
      ],
      "name": "J Frank"
    },
    {
      "affiliations": [
        "Neurology, University of Kentucky, Lexington, KY"
      ],
      "name": "J Lee"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kentucky, Lexington, KY"
      ],
      "name": "L Wise"
    },
    {
      "affiliations": [
        "Neurology, University of Kentucky, Lexington, KY",
        "Neurosurgery, University of Kentucky, Lexington, KY"
      ],
      "name": "L Perkins"
    },
    {
      "affiliations": [
        "Neurology, University of Kentucky, Lexington, KY",
        "Neurosurgery, University of Kentucky, Lexington, KY"
      ],
      "name": "M Al-Kawaz"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kentucky, Lexington, KY"
      ],
      "name": "D Dornbos"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kentucky, Lexington, KY"
      ],
      "name": "S Sizdahkhani"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kentucky, Lexington, KY"
      ],
      "name": "J Fraser"
    }
  ],
  "title": "E-143 Transfer decision-to-door-out time: the dominant driver of door-in door-out (DIDO) delay in inter-hospital stroke transfer",
  "uid": "1589abdb-ad15-5335-a08b-e8faa07fb476"
}