16 Del. Admin. Code § 4306-7.0
Current through Register Vol. 28, No. 7, January 1, 2025
Section 4306-7.0 - State of Delaware Triage, Transport, and Transfer Protocols7.1 Due to the dynamic nature of identification and evolution of best practices in prehospital care, the prehospital stroke triage guidance will be found solely in the current "State of Delaware, Department of Health and Social Services, DPH, Office of Emergency Medical Services, Statewide Standard Treatment Protocols, Guidelines, Policies, and Paramedic Standing Orders" and "Statewide Standard Treatment Protocols and Basic Life Support Standing Orders". The Stroke System Committee will provide input for the EMS Medical Director during the revision process of the standing orders.7.2 For PSCs that have neurointerventional capabilities, direct routing of prehospital patients for mechanical thrombectomy evaluation may be considered by the SSoC in collaboration with the Delaware Emergency Medical Services Oversight Council (DEMSOC)/state EMS medical director, after initial and ongoing review of data, metrics, and outcomes of neurointerventional cases performed at the PSC by the QE committee to ensure that all Delaware patients are receiving the same standard of care.7.3 Interfacility Transfer Protocol7.3.2 Rationale. The optimal outcome for the stroke patient is time dependent. It is to the patient's advantage to receive a level of medical intervention capable of providing comprehensive services for a patient's condition as promptly as possible. To perform appropriate and timely hospital-based triage, candidates for interfacility transfer must be identified quickly and the transfer process carried out promptly.7.3.3 Formal written transfer agreements and procedures must be established and made readily available to staff before the need for their implementation.7.3.4 As soon as the need for interfacility transfer is identified, the referring physician should initiate the transfer process by contacting the receiving facility following established transfer agreements and procedures. Care of the patient while awaiting transfer will be discussed by the referring and receiving physicians; the referring physician will continue to be responsible for treatment decisions and care of the patient until:7.3.4.1 The patient transfer is completed by a non-hospital-based transport service; or7.3.4.2 Care is assumed by the receiving hospital's transport team.7.3.5 The most appropriate, available mode of interfacility transportation is determined by the referring physician, with consideration of operational factors as well as clinical needs arriving at the best decision at the time of transfer request.7.3.6 Stroke patients who are to be transferred to another facility must be transported to a Delaware-recognized stroke center or a stroke center verified by TJC (or other nationally verified guidelines-based accrediting body such as Det Norske Veritas (DNV), according to the guidelines in subsections 7.3.6.1 through 7.3.6.4. These guidelines are adapted from the following American Heart Association (AHA) guidelines with additional review and recommendations of the Stroke System Committee: 7.3.6.1 Guidelines for the Early Management of Patients With Acute Ischemic Stroke (2019).7.3.6.2 Recommendations for the Establishment of Stroke Systems of Care (2019).7.3.6.3 Guidelines for Management of Patients With Spontaneous Intracerebral Hemorrhage (2022).7.3.6.4 Guidelines for Management of Patients With Aneurysmal Subarachnoid Hemorrhage (2023).7.3.7 Acute ischemic stroke patients requiring inter-facility transfer for neurointerventional evaluation for mechanical thrombectomy will go to the closest nationally certified and Delaware-recognized TSC or CSC.7.3.7.1 If the closest TSC or CSC is located outside the state of Delaware, the receiving facility will be determined by the transferring facility based upon availability of transport teams, differences in transport times, and patient/family requests, with preference given to treating Delaware stroke patients within the state of Delaware if feasible without significant delays in care.7.3.7.2 Out of state facilities treating Delaware stroke patients will be required to submit their endovascular data, metrics, and outcomes as requested by the QE Committee, and as is required of facilities performing mechanical thrombectomy within the state of Delaware. If this condition is not met, the SSoC may consider removal of that facility as a Delaware-recognized stroke center.7.3.7.3 If a stroke patient needing evaluation for mechanical thrombectomy arrives at a facility that does not have neurointerventional capabilities, and another hospital within the same health system does have neurointerventional capabilities but is not TSC or CSC certified, transfer to that hospital may be considered based upon availability of resources, transport times, and patient/family requests. These hospitals will be held to the conditions stated in subsection 7.3.7.2 of this regulation to ensure that all Delaware patients are receiving the same standard of care.7.3.7.4 Acute ischemic stroke patients without suspected LVO requiring inter-facility transfer for additional stroke evaluation or care, or post-thrombolytic care, due to unavailable resources at their current facility, will go to a nationally certified and Delaware-recognized PSC, TSC, or CSC.7.3.7.5 Hemorrhagic stroke patients (non-traumatic intracerebral hemorrhage or subarachnoid hemorrhage) requiring interfacility transfer for neurosurgical, neuro critical care, neurointerventional evaluation due to unavailable resources at their current facility, will go to a Delaware-recognized or nationally certified CSC.7.3.8 Documentation. Full documentation of the patient's course, including initial and subsequent assessment findings, treatment, and results of diagnostic studies including copies of CT scans, MRI (if available), and x-rays whenever possible should be uploaded or forwarded to the receiving hospital with or before the arrival of the patient.7.3.9 Quality Management. All transfers to or from Delaware recognized stroke centers will be reviewed for both the stroke center and Stroke System quality management processes.7.4 Follow-up and closed-loop closure. It is the responsibility of the receiving hospital to provide timely feedback to EMS and the transferring facility (as applicable) on the status and outcome of each patient received.7.5 The Delaware Stroke System of Care QE Committee chairperson may appoint a Facility Review Subcommittee to review a stroke facility's compliance with these requirements. Failure to adhere to the above requirements may result in a facility being removed from Delaware's Prehospital Stroke Triage Scheme and lose the ability to receive potential stroke patients from EMS and patient transport agencies.16 Del. Admin. Code § 4306-7.0
28 DE Reg. 390 (11/1/2024) (Final)