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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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The Procedure-Only Transfer Pathway - An Alternative to Standard Interhospital Transfer to Address Time-Sensitive

Michael Hendricks¹, Kellie Littlefield², James Clements³

¹Associate Professor and Interim Chief, Division of Hospital Medicine, Oregon Health and Science University, Portland, OR, USA.

NEJM Catalyst Innovations in Care Delivery

|July 8, 2026

Summary

Oregon Health and Science University

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Area of Science:

Minimally invasive procedures
Healthcare access
Interhospital transfer

Background:

Minimally invasive procedures are standard care but require specialized infrastructure concentrated in urban centers.
Patients in rural hospitals face delays and suboptimal outcomes due to interhospital transfer wait times for advanced procedures.
Hospital capacity constraints exacerbate delays for patients awaiting transfer for specialized care.

Purpose of the Study:

To evaluate the effectiveness of a novel procedure-only pathway for interhospital transfers.
To reduce wait times and improve access to specialized inpatient procedures for patients from referring hospitals.
To assess the impact of the procedure-only pathway on patient outcomes and hospital resource utilization.

Main Methods:

Implemented a procedure-only transfer pathway where patients are transferred solely for intervention and immediately returned.
Involved extensive multidisciplinary collaboration and stakeholder feedback for workflow refinement.
Compared wait times and outcomes for patients on the procedure-only pathway versus standard transfer.

Main Results:

Patients on the procedure-only pathway received procedures significantly faster (1.52 days vs. 4.99 days).
No significant increase in complications was observed in the procedure-only cohort.
The volume of procedure-only cases grew substantially from 8 in 2021 to 93 in 2025.

Conclusions:

The procedure-only pathway significantly decreases wait times for inpatient procedures, improving patient access to care.
This innovative model facilitates access to scarce resources, enhances patient-centered care, and optimizes bed utilization.
The pathway's success has led to expansion, including new procedural types and partnerships with more referring hospitals.