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Table 1 Actions involved in the new protocol

From: Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol

Facilities and education
Measure Description Done or not
Build a new specialty EM became its own specialty in 2013 Done
Education,
including regular feedback on DNT [10]
Educate EPs in treatment of AIS Done
Face the facts with ED staff Have a collective target-improving practice. Done
Have good cooperation between specialties Good cooperation between EM, neurology, radiology Done
Reorganize and involve the EMS [4] EMS and ED management on same wavelength. Education of EMS personnel Done
Pre-hospital
Pre-notification from EMS [4, 9] Alarm from EMS to ED triage, target 15 min before arrival Done
Single call activation system [9] Triage alerts physician and nurses at the same time Done
Patient history before arrival [4] Physician explores patient medical history from patient records if available Done
Alarm and pre-order of tests [4] Laboratory and CT referrals done at pre-notification Done
In-hospital
Face the patient in the ED lobby; whole stroke team present Patient examined upon arrival at the ED lobby on the EMS bed Done
POC INR [4] INR measured while physician examines the NIHSS Done
CT relocated to ER [4] CT located next to lobby Done
CT priority / CT with no delay [9] Free the CT table from unnecessary studies Done
Radiologist available 24/7 Oral or written report on CT available in less than 5 min Done
tPA stored in ED [10] tPA stored in primary care room Done
Premixing of tPA [4, 9] For strongly suspected AIS patients before arrival Not done
Start tPA on the CT table [4] Bolus given on CT table Sometimes
Other procedures after the bolus For example, thorax X-ray, ECG etc. Done