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Minimising time to treatment: targeted strategies to minimise time to thrombolysis for acute ischaemic stroke
Author(s) -
Tai Y. J.,
Yan B.
Publication year - 2013
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12204
Subject(s) - medicine , thrombolysis , stroke (engine) , acute stroke , medical emergency , emergency department , emergency medical services , emergency medicine , triage , intensive care medicine , nursing , mechanical engineering , myocardial infarction , engineering
Time to thrombolysis is a critical determinant of favourable outcomes in acute ischaemic stroke. It is not infrequent that patient outcomes are compromised due to out‐of‐hospital and in‐hospital time delays. On the other hand, time delays could be minimised through the identification of barriers and the implementation of targeted solutions. This review outlines the different strategies in minimising treatment delays and offers recommendations. L iterature search in P ubMed, M edline and E BSCO H ost was conducted to identify studies that are relevant to reduction of time to treatment from J anuary 1995 to D ecember 2012. Strategies to reduce time to thrombolysis are categorised into pre‐hospital strategies, in‐hospital strategies and post‐treatment decision strategies. Proposed pre‐hospital strategies include public education on stroke symptoms awareness, prioritising stroke by emergency medical services, increasing ease of access to medical records, pre‐hospital notification, and mobile computed tomography scanning. In‐hospital strategies include a streamlined code stroke system, computed tomography scanner co‐location with emergency department, 24/7 availability of stroke physicians, point‐of‐care laboratory testing and access to expert neuroimaging interpretation. Post‐decision strategies include increasing availability of intravenous thrombolysis and simplification of informed consent procurement. Time to thrombolysis delays is multifactorial. Effective reduction of time delays for acute ischaemic stroke requires the correct identification of and targeted strategies to overcome time barriers.

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