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NINDS: Stroke Proceedings: Frankel

Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke
December 12-13, 1996

Emergency Department Approach to Outcome Analysis

Michael R. Frankel, M.D. 
Emory University School of Medicine, Atlanta, Georgia

The emergency department (ED) plays a central role in the rapid identification and management of patients with acute stroke. In general, there is consensus that early recognition and appropriate intervention will lead to better patient outcome. At the present time, however, many EDs do not have mechanisms in place to efficiently and effectively manage stroke patients. Furthermore, very few hospitals have established appropriate indicators to monitor the quality of acute stroke care in the ED. While these indicators will vary somewhat depending on the characteristics of the facility, each hospital should develop the ability to monitor several key items in the continuum of care within the ED that directly affect the quality of care for patients with acute stroke.

Examples of items to monitor include issues related to time, morbidity, and mortality. Since early treatment is the cornerstone of effective stroke management, monitoring the following time periods will help improve the speed of movement through the ED:

  • Door to physician evaluation
  • Door to CT table
  • Door to needle (for patients receiving intravenous t-PA)

Monitoring requirements for morbidity and mortality could include:

  • Symptomatic intracerebral hemorrhage within 36 hours of receiving thrombolytic therapy.
  • Adherence to the selection criteria and management guidelines for the use of intravenous t-PA.
  • Functional status at 3 months, discharge level of disability, or death, subdivided into ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage etiologic groups.


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Last Edited: July 01, 1999

National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

Last Modified May 17, 2011