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
- EMS pre-notification
- Rapid triage protocol and stroke team notification
- Single call to active stroke team
- Stroke tools
- Rapid imaging and interpretation
- Rapid laboratory testing and POC test
- Premixing rt-PA
- Rapid access to rt-PA
- Team-based approach
- 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
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
- 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.
- NINDS NIH website. Stroke proceedings. Latest update 2008.
- Personal communication, Peter Schellinger, Jan 2011.