Table 1 Implementation strategies to improve acute stroke care measures

1. Detailed stroke care protocols in the ED

Provision of guidelines and instructions on how to implement stroke care readily available in ED

Develop and disseminate stroke care protocols in the ED

ED supervisor

ED providers

Ongoing

Standardize stroke care, improve quality of care, reduce time to acute stroke treatment, guideline-concordant tPA use

2. Stroke care education and tPA competency training

Education of staff on stroke protocols and guidelines and provision of interactive training on tPA administration

In-person group training on stroke protocols and tPA administrate-on

ED providers, nurse educators (doctors, nurses)

ED providers (doctors, nurses)

annual

Improve quality of care via increased awareness and familiarity with stroke protocols and self-efficacy with tPA administration, guideline-concordant treatment

3. Modification of the timing of CT brain imaging in acute stroke care

Taking the patient directly to the CT scanner upon hospital arrival

Routing patient to the CT scanner immediately on arrival

ED administrators

ED providers

Ongoing

Reduce time to acute stroke treatment (door-to-needle time)

4. Increased access to tPA in the ED

Storage of tPA in the ED

Storing tPA in the automated dispensing cabinets in the ED

Pharmacy

ED nurse

Ongoing

Reduce time to acute stroke treatment

5. Additional staff to support implementation of acute stroke care protocols

Supporting actions of ED staff during an acute stroke care protocol

Supporting behavior of ED staff during an acute stroke care protocol and providing assistance when needed

Stroke program manager, senior nurses, trauma nurse

ED staff involved in acute stroke care protocol

Ongoing

Increase fidelity of implementation of acute stroke care protocols to improve quality of care, timeliness of tPA treatment