Improve acute stroke processes

Organized stroke care and establishment of stroke centers are critical to a fast and efficient response, which may lead to improved patient outcomes. These systems of stroke care encourage collaboration, education, and continuous assessment and refinement.¹

Sharing best practices improves stroke systems^1-3

The golden hour of stroke treatment

The National Institutes of Health recommends time intervals for Activase (Alteplase)–eligible acute ischemic stroke patients presenting to the emergency department to receive treatment within 60 minutes.⁴

• 0 min: Suspected acute ischemic stroke patient arrives at hospital
• <10 min: Initial MD evaluation (including patient history, lab work initiation, and NIHSS assessment)
• <15 min: Stroke team notified (including neurologic expertise)
• <25 min: CT scan initiated
• <45 min: CT and labs interpreted
• <60 min: Activase (t-PA) given if patient is eligible*

• *
• Activase (t-PA) must be administered within 3 hours of symptom onset.

• NIHSS=National Institutes of Health Stroke Scale.

Keys to improving stroke care⁵

• Team approach — collaboration among all personnel and services
  • – Set goals
  • – Hold regular meetings
  • – Establish feedback loop between departments
  • – Develop educational programs for EMS and staff
• Protocols — standardize the approach and execution
  • – Set up care paths, standing orders, protocols and/or flow charts, stroke scales
  • – Identify performance measures and methods for improving procedures and systems
• Self-assessment — challenge staff by tracking their progress
  • – Identify and address potential obstacles to successful implementation
  • – Assess performance measures
  • – Obtain input from stroke team on quality assessment
• Patient outcomes sharing
  • – ED, EMS, hospital staff, and stroke team collaboration
  • – Establish feedback loop of lessons learned/success stories

Time = Brain

Every minute counts⁶

Permanent neurologic damage is more likely to occur the longer a stroke goes untreated⁶

Rapid intervention is crucial in the treatment of stroke. For every minute a stroke goes untreated, as many as⁷...

• 1.9 million neurons are lost
• 14 billion synapses are lost
• 7.5 miles of myelinated fibers are lost

Golden Hour Poster

The Golden Hour Poster includes NIH guidelines for the treatment of stroke, plus time-saving practices submitted by leading stroke centers.

Submit your stroke center's best practices!

Quality Assessment Tracker

Helps you support your institution's commitment to quality stroke care by utilizing the downloadable tracking log for important quality measures for stroke response. You'll also find ideas you may wish to incorporate from the best practices provided by 3 Stroke Centers of Excellence.