When a stroke strikes, time is one of the most important factors that decides whether a person can recover or live with long-term disability.
A new large study published in The Lancet Neurology shows that serious delays in transferring stroke patients between hospitals in the United States are reducing their chances of receiving life-saving treatment and increasing the risk of leaving hospital with permanent disability.
A stroke happens when blood flow to part of the brain is blocked. This type of stroke is called an ischemic stroke and makes up the majority of all strokes. Without blood and oxygen, brain cells begin to die very quickly.
For many patients, a modern treatment called endovascular thrombectomy can remove the clot directly from the blood vessel. This treatment has been available for more than ten years and has dramatically improved survival and recovery for stroke patients.
However, not every hospital can perform this advanced procedure. Around one-third of ischemic stroke patients are suitable for thrombectomy, but more than 40 percent of those who eventually receive it first arrive at hospitals that do not offer the treatment.
These patients must be transferred to larger, better-equipped stroke centers. This is where the problem begins.
The time a patient spends at the first hospital before being transferred is known as door-in-door-out time. This includes the time needed for diagnosis, imaging, decision-making, and arranging transport. The American Heart Association recommends that this process should take no longer than 90 minutes. In reality, many patients wait much longer.
Researchers from the University of Chicago Medicine and the University of Michigan studied data from more than 20,000 stroke patients across the United States. They found that only about 26 percent of patients were transferred within the recommended 90 minutes. Many waited several hours before leaving the first hospital.
The study showed a clear and alarming pattern. As transfer times increased, patients were far less likely to receive thrombectomy. Those whose transfer took between 91 minutes and three hours were already 29 percent less likely to get the treatment. For patients whose transfer took more than four and a half hours, the chance dropped by 65 percent.
These delays had real consequences. Patients who waited longer had worse recovery outcomes. Doctors use a scale to measure how much a stroke affects daily life, including walking, speaking, and self-care.
Patients with longer transfer times scored worse on this scale. They also had more complications after treatment and were less likely to walk independently when they left hospital.
Senior researcher Dr. Shyam Prabhakaran explained that the results confirmed what doctors have long suspected. Every minute of delay means more brain damage. Saving even small amounts of time can improve a patient’s chance of recovery.
While hospitals have made great progress in speeding up clot-busting drugs at the first hospital, the transfer process has not improved at the same pace.
The study also highlights deeper system-level problems. Many regions, especially rural areas, lack organized stroke care networks.
Ambulance availability, coordination between hospitals, staffing shortages, and unclear transfer protocols all contribute to delays. Previous national data showed that the average transfer time was close to three hours, far above recommended limits.
The researchers believe that stroke care systems must now focus on transfer speed with the same urgency that was once applied to emergency stroke treatment inside hospitals.
Quality improvement programs around the world have successfully reduced treatment delays once patients arrive at emergency departments. Similar strategies could be used to reduce transfer delays.
There is already work underway to test solutions. A new clinical trial called HI-SPEED is examining whether structured hospital protocols can shorten transfer times and improve patient outcomes. The study is being tested across several major U.S. health systems.
The researchers also stress that improvement should start even earlier. Better tools for ambulance teams could help identify stroke patients who are likely to need thrombectomy and take them directly to specialized centers, avoiding transfer delays altogether.
Looking closely at the findings, this study sends a strong message. Advanced stroke treatments save lives, but only if patients can access them in time.
The science behind thrombectomy is well established, yet system delays are preventing many people from benefiting. The results show that the problem is not a lack of technology, but a lack of speed and coordination.
In summary, the study provides powerful evidence that hospital transfer delays are a major and preventable cause of disability after stroke. Improving transfer systems could dramatically increase access to effective treatment and help more patients regain independence.
Every minute saved truly matters, and addressing these gaps could change the lives of thousands of stroke survivors each year.
If you care about stroke, please read studies that diets high in flavonoids could help reduce stroke risk, and MIND diet could slow down cognitive decline after stroke.
For more health information, please see recent studies about antioxidants that could help reduce the risk of dementia, and tea and coffee may help lower your risk of stroke, dementia.
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