title: Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative.
abstract: OBJECTIVE
  The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time-dependent, and guidelines recommend a door-to-needle time of ≤60 minutes. However, fewer than one third of acute ischemic stroke patients who receive tPA are treated within guideline-recommended door-to-needle times. This article describes the design and rationale of
  
  
  OBJECTIVE
  Stroke, a national initiative organized by the American Heart Association/American Stroke Association in partnership with other organizations to assist hospitals in increasing the proportion of tPA-treated patients who achieve guideline-recommended door-to-needle times.
  
  
  METHODS
  The initial program goal is to achieve a door-to-needle time≤60 minutes for at least 50% of acute ischemic stroke patients. Key best practice strategies previously associated with achieving faster door-to-needle times in acute ischemic stroke were identified.
  
  
  RESULTS
  The 10 key strategies chosen by
  
  
  OBJECTIVE
  Stroke include emergency medical service prenotification, activating the stroke team with a single call, rapid acquisition and interpretation of brain imaging, use of specific protocols and tools, premixing tPA, a team-based approach, and rapid data feedback. The program includes many approaches intended to promote hospital participation, implement effective strategies, share best practices, foster collaboration, and achieve stated goals. A detailed program evaluation is also included. In the first year,
  
  
  OBJECTIVE
  Stroke has enrolled over 1200 United States hospitals.
  
  
  CONCLUSIONS
  
  
  
  OBJECTIVE
  Stroke, a multidimensional initiative to improve the timeliness of tPA administration, aims to elevate clinical performance in the care of acute ischemic stroke, facilitate the more rapid integration of evidence into clinical practice, and improve outcomes.
authors: University of California, Los Angeles, Department of Neurology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
authors: Gregg C
authors: GC
authors: Fonarow
authors: Eric E
authors: EE
authors: Smith
authors: Jeffrey L
authors: JL
authors: Saver
authors: Mathew J
authors: MJ
authors: Reeves
authors: Adrian F
authors: AF
authors: Hernandez
authors: Eric D
authors: ED
authors: Peterson
authors: Ralph L
authors: RL
authors: Sacco
authors: Lee H
authors: LH
authors: Schwamm
mesh_terms: D000572:American Heart Association; D002545:Brain Ischemia / Q000188:drug therapy*; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator