title: Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol.
abstract: BACKGROUND
  Tissue plasminogen activator (tPA) treatment for acute ischaemic stroke (AIS) should be given as soon as possible, preferably within 60 min after arrival at hospital. There is great variation in door-to-needle times (DNTs) internationally, nationally and even within the same hospital. Various strategies for improving treatment delays have been presented. The role of emergency physicians (EPs) in treating AIS has been under discussion in recent years. Emergency Medicine (EM) officially became a specialty in Finland in 2013. Practical education of EPs in Kanta-Häme Central Hospital began in October 2012, together with reorganization of the in-hospital treatment path for AIS patients. The main change was shifting the on-call duty regarding stroke patients from internists or neurologists to EPs after the third quarter of 2013.
  
  
  METHODS
  This was a retrospective study. The data, concerning the characteristics of tPA-treated patients, DNTs and onset-to-treatment times (OTTs) was collected from electronic and paper records. The period studied was 1 year before and 1 year during reorganization, i.e. 2012 and 2013.
  
  
  RESULTS
  During the study period a total of 64 tPA treatments were given, 31 before and 33 during reorganization. The median DNT was 54 min in 2012, while it was 28 min in 2013 (p < 0.001). The median OTTs were 139 and 101 min before and during the start of reorganization, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Both total and in-hospital delays in the treatment of ischaemic stroke were shortened significantly during reorganization. Emergency physicians are able to treat AIS patients within international time guidelines. Success was based on scrutinized reorganization and good cooperation between neurologists, EPs and radiologists.
authors.affiliation: Department of Emergency Medicine, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland. iiro.heikkila@fimnet.fi.
authors.forename: Iiro
authors.initials: I
authors.lastname: Heikkilä
authors.affiliation: Department of Neurology, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kuusisto
authors.affiliation: Department of Neurology, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland.
authors.forename: Alexandr
authors.initials: A
authors.lastname: Stolberg
authors.affiliation: Department of Emergency Medicine, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland.|School of Medicine, University of Tampere, FI-33014, Tampere, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Palomäki
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005387:Finland; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischaemic stroke; Emergency department; Emergency medicine; Thrombolysis; reorganization