Introduction of an Acute Stroke Team: An effective approach to hasten assessment and management of stroke in the emergency department
Recombinant tissue plasminogen activator (rtPA) reduces the combined endpoint of death and disability if given within three hours of onset of ischaemic stroke. However few patients receive rtPA, with delays in in-hospital evaluation and treatment being key barriers to therapy. The Austin Hospital Acute Stroke Team (AST) was introduced with the aim of improving the speed of assessment and management of acute stroke patients presenting to the emergency department. We sought to assess the effect of the AST on number of eligible patients receiving rtPA and assessment times within our already active stroke service. Data were obtained prospectively for all AST calls during the period from 17 January 2005--31 December 2005. Information recorded included: demographics, time of call, clinical features, diagnosis and any treatment with rtPA. Information prospectively acquired from patients receiving stroke thrombolysis the previous year was also analysed. There were 663 stroke unit admissions and 224 AST calls during the study period. 53% of calls occurred within working hours and 68% had a final diagnosis of stroke. Twenty-seven patients received treatment with rtPA (12% of calls), whereas only ten patients received rtPA in 2004. The most common reason for not treating was mild or rapidly resolving deficit. Onset-needle time and door-needle times significantly improved following introduction of the AST. Thus, we conclude that the introduction of the AST emergency call system has increased the number of eligible patients receiving rtPA. Improved onset-needle and door-needle times are achievable by this team approach.