Abstract
Background: Rambam Medical Center is the biggest hospital in northern Israel, serving an estimated population of 2,000,000 people. Every year there are as much as 1000 patients hospitalized in Rambam with the diagnosis of acute ischemic stroke. Rambam hospital has facilities for giving all possible types of fibrinolytic treatment in patients with acute ischemic stroke. Methods: We use a special algorithm looking for immediate identification of acute ischemic stroke admitting to ER and then a special neurology nursing stroke team (in cooperation with stroke neurologist) provides fast and complete diagnostic work-up, including imaging battery. Since June 2013 we practice to start a thrombolytic treatment at CT department on CT table immediately after regular brain CT is completed. Results: Using the current approach the minimal time of door-to-needle was reduced to 27 minutes in 2014 as compared with minimal time of 43 minutes in 2012 and 46 minutes in 2011. Conclusions: Start of IV Tpa treatment on CT table significantly reduces door-to-needle time for acute stroke patients. Use of such protocol requires dedicated stroke neurology nursing team.
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