Background:  
Stroke Endovascular Therapy (EVT) is a highly specialized neurointerventional procedure provided at regional or tertiary level stroke centres. It requires a regional approach, building on existing local thrombolysis protocols to ensure timely referral and transfer for EVT. Within Central South Ontario, half of the EVT patients treated at the regional EVT centre are from referring sites. As a result, it is imperative to develop a regional drip and ship protocol to support the safe and timely transfer to the EVT centre and minimize delays to transfer. 
 
Methods:
Consultation with local EMS providers identified the necessary protocols required to support safe transport. An environmental scan of existing Drip and Ship Protocols was completed. Representatives from referring thrombolysis centres were brought together to develop a regional drip and ship order set to support the safe transport of EVT patient who receive IV thrombolysis (tPA )and those who have not received IV tPA to the endovascular centre.  
 
Results:
Local drip and ship protocols were developed that addressed: 1) EVT pre-procedural orders; 2) vital sign and neurological monitoring: 3) monitoring and management of tPA complication; 4) management of contrast dye allergic reaction; and 5) other symptom management on route. In addition to the Drip and Ship Order sets, centres developed EVT Transport Order Sets, Patient EVT Transfer Policies, EVT Transport Checklists; EVT Transport Medication Kits and Transfer Documentation Records. 
 
Conclusions:
Collaborative development of a regional drip and ship process has supported the safe transport of regional EVT cases and limited delays to treatment.

Development of a Regional Drip and Ship Protocol at Referring Stroke Thrombolysis Centres to Support Timely Access to Stroke Endovascular Therapy