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Stroke Research and Treatment
Volume 2011, Article ID 198518, 8 pages
Research Article

A Parallel Thrombolysis Protocol with Nurse Practitioners As Coordinators Minimized Door-to-Needle Time for Acute Ischemic Stroke

1Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
2Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
3Department of Neurology, Landseed Hospital, No. 77, Kwang-Tai Rd., Ping-Jen City 32449, Tao-Yuan County, Taiwan
4Department of Neurology, National Taiwan University Hospital, No. 7, Chung Shan S. Rd., Taipei 100, Taiwan

Received 3 August 2011; Revised 12 September 2011; Accepted 12 September 2011

Academic Editor: David S. Liebeskind

Copyright © 2011 Sheng-Feng Sung et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Quick thrombolysis after stroke improved clinical outcomes. The study objective was to shorten door-to-needle time for thrombolysis. Methods. After identifying the sources of in-hospital delays, we developed a protocol with a parallel algorithm and recruited nurse practitioners into the acute stroke team. We applied the new protocol on stroke patients from October 2009 to September 2010. Patients from the previous two years were used for comparison. Results. For ischemic stroke patients within 3 hours of onset, the median time from arrival to computed tomography scanning was reduced from 29 to 20 minutes ( 𝑃 < 0 . 0 0 1 ) and the median time from arrival to neurology evaluation decreased from 61 to 43 minutes ( 𝑃 < 0 . 0 0 1 ). For those patients who received thrombolysis, the median door-to-needle time was shortened from 68.5 to 58 minutes ( 𝑃 < 0 . 0 5 ). Conclusions. The parallel thrombolysis protocol successfully improved the median door-to-needle time to below the guideline-recommended 60 minutes.