In-hospital management

The main limitation for the application of stroke treatment is represented by time. Therefore, alongside pre-hospital stroke care, the optimisation of in-hospital management and processes, especially rt-PA application, is essential to reduce or avoid delays.

Target: Stroke – Improving door-to-needle times

Stroke guidelines recommend a door-to-needle time of ≤60 minutes. However, only few ischaemic stroke patients are treated within guideline-recommended door-to-needle times.

Target: Stroke, a quality improvement initiative from the AHA/ASA focused on reducing door-to-needle times for eligible acute ischaemic stroke patients being treated with rt-PA by applying 10 key best practice strategies:1

  1. EMS pre-notification
  2. Rapid triage protocol and stroke team notification
  3. Single call to active stroke team
  4. Stroke tools
  5. Rapid imaging and interpretation
  6. Rapid laboratory testing and POC test
  7. Premixing rt-PA
  8. Rapid access to rt-PA
  9. Team-based approach
  10. Rapid data feedback

DTN≤ 60 min: The “golden” hour

Improved treatment routines lead to an increase in the number of patients treated within DTN≤ 60 min.2

treatement routines

Preparing the patient for rt-PA in 30 min (optimally 15 min)

Reduction of the DNT to 30 minutes or less can be achieved by optimisation of in-hospital stroke care.3

Preparing the patient for rt-PA in 30 min (optimally 15 min)

  1. Fonarow GC, et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: Stroke initiative. Stroke 2011;42:2983-2989.
  2. NINDS NIH website. Stroke proceedings. Latest update 2008.
  3. Personal communication, Peter Schellinger, Jan 2011.