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 | ||
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 |
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 |