Prehospital Notification and En Route Labs Draw for Acute Ischemic Stroke Reduces the Door to Decision Making Time

OBJECTIVE: To check the effectiveness of Prehospital Notification and en route labs draw for Acute Ischemic Stroke(AS) on Door to Decision making time. BACKGROUND: NINDS trial showed that IV tPA improves functional outcome but therapy is limited by time passed. Protocols should be developed to minimize the delay at any step possible. DESIGN/METHODS: We retrospectively investigated door to decision making time for AS cases with EMS notification and en route lab draw and compared with cases without notification and lab draw. RESULTS: Between July 2009 and August 2012, EMS transported 401 patients with AS/TIA to our stroke center. Out of 401 patients, 341 patients arrived with pre-hospital notification. Among patients who arrived with pre-hospital notification, 89% patients received NIHSS within 5 minutes of arrival. In 67% of patients, AS team was present before arrival of the patients. These patients followed ED stroke algorithm that included, NIHSS, review of CT scan and labs, discussion with patient, family and stroke team attending. 91% of these patients received medical decision making: IV thrombolytic, catheter based reperfusion or neither within 40 minutes (average 38.5 minutes) from the door time. Out of 56 patients who received IV Thrombolytic, en route Blood draw was performed in 12 patients leading to a door to needle time of less than 30 minutes compared to average 38.5 minutes. The en-route lab draw reduced the door to lab interpretation time by 12.5 minutes. In 60 patients without pre hospital notification, decision making time was longer than 50 minutes (average 52.5). CONCLUSIONS: Our results indicate that prehospital notification significantly reduces the door to decision making time due to efficient utilization of stroke team, CT scanner and laboratory services. En route Blood draw further helped to reduce the door to needle time by significant reduction in door to lab interpretation time. Disclosure: Dr. Ruff has nothing to disclose. Dr. Uppal has nothing to disclose. Dr. Sandhu has nothing to disclose. Dr. Beezley has nothing to disclose. Dr. Nanda has nothing to disclose. Dr. Singh has nothing to disclose.