Stroke is the fifth-leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC), and a leading cause of disability. The debilitating condition costs the nation an estimated $34 billion each year to cover healthcare services, medications and missed work.

Timely diagnosis and treatment is essential to ensure the best possible outcome for patients suffering strokes. Recent research shows reducing the time it takes for patients to access medical treatment contributes to the success of the endovascular therapy they receive.

Yet delays in emergency transport are still common despite widespread efforts to improve transport time, according to a new study.

The research, presented at the 12th annual meeting of the Society of NeuroInterventional Surgery (SNIS), suggests efforts to improve public education, 911 dispatch procedures, triage and prehospital care, and stroke system and stroke unit management in hospitals were not enough to ensure treatment during the optimal timeframe for care.

"The challenge to improve upon stroke systems of care is an opportunity to transform the way we approach stroke treatment," said Dr. Donald Frei, president of SNIS. "And we're seeing the most progress in the cities, states and regions that are engaging in collective efforts to ensure that patients go to the hospital that is best equipped to treat stroke."

Door to treatment in 60 minutes or less is the gold standard for stroke care, but most U.S. stroke patients are transported to a regional center unequipped to treat the condition. This means the patients must move to a second treatment center to get the specialized care they need.

Hospital-to-hospital transfers can extend door-to-treatment times, frequently past that "golden hour" mark.

In the study, titled "Evaluation of Transfer Times for Emergent Stroke Patients from Regional Centers to a Comprehensive Stroke Center," the researchers recorded 70 patient hospital-to-hospital transfer times occurring within one year. The scientists evaluated transfer times from the six regional medical centers within a 120-mile radius to Vanderbilt University Medical Center in Nashville, Tennessee. The hospitals ranged in distance from 18 to 119 miles to the Nashville medical center.

Triage indicated acute stroke with the urgent need for transfer in all cases. The researchers defined transfer time as the interval between the initial request for transfer and patient arrival at Vanderbilt. The scientists averaged the times for each referring hospital. They then used Google Maps to estimate driving times. The researchers excluded patient transfers that did not have a precise arrival time.

The average transfer time was 97.8 minutes overall. In every case, the transfer times significantly exceeded the expected driving times. The average differences per hospital ranged from 46 minutes to 133 minutes.

Efficient transport, prompt diagnosis and care from a multidisciplinary team improve outcome in stroke patients. While there have been significant improvements in these systems, the study suggests there is still room for more.