A protocol‐driven model for the rapid initiation of stroke thrombolysis in the emergency department

Abstract

Objective: To assess efficacy and safety of a 24‐hour comprehensive protocol‐driven model for rapid assessment and thrombolysis of stroke patients in the emergency department. Design: Prospective open observational study. Participants and setting: All patients with acute stroke presenting within 3 hours to the St Vincent's Hospital (Sydney) emergency department between 1 December 2004 and 30 July 2005. Main outcome measures: Proportion of patients treated, patient demographics, clinical outcome, adverse events and time to treatment parameters. Results: 134 patients (100 stroke; 34 transient ischaemic attack) were admitted to the stroke unit during the study period. Of the 100 stroke patients, 40 presented within 3 hours of symptom onset. Fifteen patients had no contraindications and received intravenous thrombolysis. At 3 months, 10 patients (67%) were independent (modified Rankin score [mRS], 0–2) and seven (47%) had an excellent functional outcome (mRS ≤ 1). Symptomatic intracranial haemorrhage was not observed. The median time from symptom onset to tissue plasminogen activator treatment was 155 minutes (range, 105–197 min). Median onset‐to‐door, door‐to‐computed tomography, and door‐to‐needle times were 48, 25, and 87 minutes, respectively. Conclusion: Rapid assessment of stroke in the emergency department according to a comprehensive protocol allows identification and treatment of acute ischaemic stroke patients eligible for thrombolysis.

Improving access to acute stroke therapies: a controlled trial of organised pre‐hospital and emergency care

“…Baseline stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS) 7 was worse in our cohort than comparators. Despite this, 43% of our tPA group had minimal or no disability at 3 months, which is at least equivalent to national and international benchmarks 19 , 22 …”

The implementation of intravenous tissue plasminogen activator in acute ischaemic stroke – a scientific position statement from the National Stroke Foundation and the Stroke Society of Australasia

“…Tissue plasminogen activator was approved for use by the Therapeutic Goods Administration in August 2003. Although tPA use is still low in Australia, 5 it is being used in an increasing number of emergency departments and stroke units, where Australian audit and registry data indicate acceptable safety outcomes 27–29 . The major practical consideration to implementation of tPA is the defined 3‐h time window in which to commence tPA.…”

“…Physicians 2001 26 registry data indicate acceptable safety outcomes. [27][28][29] The major practical consideration to implementation of tPA is the defined 3-h time window in which to commence tPA. Of near equal importance are the associated health system issues.…”

Implementation evaluation and refinement of an intervention to improve blunt chest injury management—A mixed‐methods study

“…To address the evidence‐practice gap in patients with blunt chest injury, the Trauma and Emergency Departments (ED) in our Level 1 Trauma Centre collaborated with the pain, physiotherapy and aged care teams to develop a Chest Injury Protocol (ChIP) that consolidated the best available evidence on treatment of blunt chest injury (Curtis et al., ; Unsworth, Curtis, & Asha, ). Comparable to a trauma team call (Davis et al., ) or “stroke page” (Batmanian et al., ), which are known to improve patient and health service outcomes, ChIP is an early activation protocol that facilitates individually tailored, multidisciplinary management of blunt chest injury, including multimodal analgesia to optimise respiratory function. Early notification enables rapid multidisciplinary assessment and care tailored to the individual needs dependent on their premorbid condition.…”