If any delays or glitches happen in transferring a stroke patient for time-sensitive treatment and the family sues, a plaintiff attorney is sure to make a huge issue of it.

To learn more about stroke transfer processes, researchers interviewed 45 staffers, nurses, and physicians at three emergency departments (EDs).1

“We focused specifically on the organizational aspects of the transfer, because they have received less attention than medical protocols,” says Tim Vogus, PhD, professor of management at Vanderbilt’s Owen Graduate School of Management. Participants explained what specifically made transfers go smoother:

Protocols that standardize transfer processes, reducing unnecessary communication. Researchers were struck by “the incredible importance of pre-structuring the interaction,” Vogus says.

Auto-accept protocols focused conversations on the most important pieces of information. This way, ED staff did not have to waste valuable time convincing the receiving center to accept the patient in the first place.

Direct communication with the neurology team at the receiving center. It turned out that relationships between the sending and receiving centers mattered a great deal. “It’s not just about sending a patient to a better-resourced facility,” Vogus notes.

A nice rapport between the two people initiating and receiving the transfer sped up the process. “Clear conversation, where there was clarity about what needed to happen, was easier,” Vogus explains.

ED staff reported that they rarely, if ever, learned anything about how things went after the patient arrived at the receiving facility. Without post-transfer feedback, the sending ED has no way to know if they made a good decision to transfer the patient. They also will not know if anything they did in the ED helped the patient experience a good outcome.

“This is a missed opportunity for the people working at the transferring center,” Vogus says. Some examples of helpful information for the transferring ED:

  • data (e.g., test results) that the receiving facility wishes they would have had;
  • how long it took for the patient to arrive at the receiving hospital;
  • the patient’s outcome.

If it took too long to arrive at the receiving facility, Vogus says the transferring hospital could explore alternate modes of transport. Understanding travel times can help everyone learn how that could positively or negatively affect patient outcomes.

The receiving hospital could automatically provide feedback via a link to a report on how things went. “Alternatively, transferring hospitals could opt in to whether they wanted the feedback,” Vogus says.


  1. Hayes M, Schlundt D, Bonnet K, et al. Tales from the trips: A qualitative study of timely recognition, treatment, and transfer of emergency department patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2019;28:1219-1228.