Sustainably High Thrombolysis Rates Through Smart Criteria Training Of Emergency Physicians: 10 Year Results

Introduction: Thrombolysis rates remain low. One important factor is emergency physician (EP) participation. We routinely trained EPs to use SMART (Simplified Management of Acute Stroke Using Revised Treatment) criteria with real time feedback, resulting in high thrombolysis rates. The goal of this study was to determine the sustainability of this approach. Methods: Retrospective analysis of all consecutively treated IV rt-PA treated patients from 1/2006-6/2017, presenting to the ED at a large tertiary/quaternary stroke referral center. All EPs are trained using SMART criteria, which greatly lessen the contraindications to thrombolytic treatment. In addition the protocol requires response by the stroke neurologist ≤10min, and continuous real time feedback to the EP to maximize physician training. Formal in-service training is de-emphasized. Data regarding thrombolysis rates, and patient characteristics were routinely collected, including outcomes, safety and mortality. Results: From 1/06 to 6/17, 524 pati...