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Stroke Care in the Emergency Room

Ischemic stroke is a type of stroke where a blockage in the blood vessels in the brain causes damage to brain tissue. Research has shown that some patients suspected of having a stroke benefit from the administration of Tissue plasminogen activator (IV-rtPA) to dissolve blood clots that cause the blockages in blood flow to the brain. IV-rtPA has been shown to be effective when administered within 4.5 hours from the onset of stroke symptoms, but most effective, when administered within 3 hours from onset of symptoms.

Door to IV rt-PA Time

The percentage (%) of patients diagnosed and treated for ischemic stroke within 60 minutes (1 hour) of arriving in our Emergency Department, and who arrived at our Emergency Department within 2 hours of their stroke symptoms beginning.

Why is this important?

To be most effective, stroke patients should receive IV-rtPA within 3 hours of the onset of stroke symptoms. Thus, reducing the time to administration of IV-rtPA in the Emergency Department is critical to providing the best emergency care for stroke patients.

What is our performance telling us?

BIDMC reports its performance on this measure every quarter to the Massachusetts Department of Public Health Primary Stroke Service Registry. The chart below shows BIDMC's annual performance over the last three years, compared to the goal of 100%.

BIDMC's goal is to treat all qualifying patients with IV rt-PA within 60 minutes of arrival in the ED however there are some circumstances which occur in which a patient receives effective treatment with IV rt-PA 61 minutes or longer after arrival in the ED.

In the most recent calendar year (CY 2011), 100% of the patients who qualified to receive IV rt-PA were treated within 60 minutes of their arrival.  BIDMC's performance meets the goal.

What are we doing to improve?

To improve emergency care for stroke patients, BIDMC routinely monitors time from ED arrival to IV-rtPA treatment to drive improvement in performance. Improvements in emergency stroke care include:

• Automated alerts to immediately page Stroke Team members to the ED bedside, to initiate neurological care, expedite CT scanning and streamline critical blood work. 
• Established a Code Stroke Review Committee which reviews all stroke diagnoses and potential cases, to identify opportunities for continued improvement in patient care processes throughout the Medical Center.

Last Updated:  March 21, 2012