ABSTRACT NUMBER: ESOC2026A2071 PITSTOP: A SERVICE EVALUATION OF A SYSTEMS-LEVEL INTERVENTION TO REDUCE INTERHOSPITAL TRANSFER DELAYS FOR ENDOVASCULAR THROMBECTOMY

Abstract Background and aims Interhospital transfer delays limit timely endovascular thrombectomy (EVT) for patients with large vessel occlusion (LVO), with transfer from Primary Stroke Centre (PSC) to Comprehensive Stroke Centre (CSC) often delayed by ambulance availability. Following a pilot, the National Thrombectomy Service (NTS), National Ambulance Service (NAS) and four PSCs in Ireland initiated the Protocol for Improving Times for STroke patients requiring Onward Transfer (PITSTOP) whereby ambulance crew remain at PSC until transfer suitability is decided. This evaluation assesses the impact of PITSTOP on pathway metrics and functional outcomes. Methods Timepoint and functional outcome metrics were collected for consecutive EVT patients using PITSTOP and standard pathways. Baseline characteristics included age, stroke severity (NIHSS), modified Rankin Scale (mRS), witnessed stroke status, and thrombolysis status. Primary outcomes were pathway timepoints; door-to-CT brain, door-to-decision, decision-to-door-out time, and door-in-door-out (DIDO) time. The secondary outcome was functional status (mRS) at 90 days. Results Preliminary results show baseline characteristics, including NIHSS and mRS, were comparable between both groups (PITSTOP n=147; standard practice n=296). PITSTOP was associated with significantly shorter times for door-to-CT (20.7vs25.9mins,p=0.002), door-to-decision (55.0vs72.1mins,p<0.001), decision-to-door-out (24.3vs41.1mins,p<0.001) and DIDO (79.1vs113.4mins, p<0.001). At 90 days, functional independence (mRS 0–2) was higher with PITSTOP than standard practice (53.5%vs 45.5%,p=0.081). Conclusions This service evaluation demonstrates that system-level redesign of ambulance utilisation can significantly reduce EVT transfer delays, with greatest impact on decision-to-door-out time, the focus of PITSTOP. Furthermore, improvements in earlier timepoints suggest secondary pathway effects, warranting further evaluation of how system level interventions influence the LVO care pathway. Conflict of interest Nothing to disclose