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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