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How a CT-Direct Protocol at an American Comprehensive Stroke Center Led to Door-to-Needle Times Less Than 30 Minutes.


Intravenous tissue plasminogen activator (IV tPA) efficacy, following acute ischemic stroke (AIS) is contingent on expeditious administration. In 2014, a study involving computed tomography-Direct protocol to increase efficiency when evaluating suspected patients with AIS, was conducted by Lisa M. Caputo, MA, Judd Jensen, MD, Michelle Whaley, MSN, Mark J. Kozlowski, MD, FACEP, Christopher V. Fanale, MD, Jeffrey C. Wagner, MD, Alessandro Orlando, MPH, and David Bar-Or, MD. The goals of the study were to "describe the protocol development and implementation process, and to compare DTN (door to needle) times and symptomatic intracranial hemorrhage (sICH) rates before and after protocol implementation." The results derived from the study indicate that implementing a protocol, which streamlines the processing for patients suspected of having AIS, dramatically lessened DTN time without having a detrimental impact on patient safety.