Attachment C
PRIMARY STROKE SERVICES
    TIME TARGET RECOMMENDATIONS 

                        The following chart is provided to assist hospitals assess the timeliness of activities related to stroke evaluation and diagnosis. 
                        Some of the activities listed below will occur concurrently.  The Department recognizes actual individual timeframes may vary, 
                        and individual time targets may not apply to all patients.  However, the goal for the initiation of IV t-PA remains at one hour from the 
                        time of patient arrival in the Emergency Department.

Category	Recommendation	Time Targets	
Category I:
Ongoing data collection requirement	ED door-to-needle time for IV thrombolytic (tPA) treatment  	within 60 min of patient arrival in ED	
	Time from door to CT scan or MRI scan performance 	within 25 min of admission	
Category II:

When delays in care are identified, use the time targets as part of a quality improvement drill-down to resolve the delays.	Time from patient arrival at ED to notification of Acute Stroke Team (AST), i.e., making the call to the team 	within 15 min of arrival	
	Time from completion of CT scan or MRI scan to interpretation by physician 	within 20 min of completion of scan	
	Time from order of ECG to performance through completion of ECG and interpretation 	within 45 min of being ordered	
	Time from order of lab tests to completion of tests, report of results, and interpretation	within 45 min of being ordered	
	Time from notification of AST to response of team member by phone, video or at patient bedside to assess patient as appropriate 	within 15 min of being called	
	Time from order of chest X-Ray, if indicated, to performance through completion of chest X-Ray and interpretation 	within 45 min of being ordered	
	Time from order of neurosurgical evaluation to start of evaluation; includes transfer to another hospital for such evaluation, if applicable 	within 2 hours of being deemed clinically necessary	
	Neurosurgical intervention	as needed urgently	
 Source of all time targets, unless otherwise noted, is “Recommendations for the Establishment of Primary Stroke Centers,” JAMA 2000; 283:3102-3109.
2 NINDS proceedings of national symposium on Rapid Identification and Treatment of Acute Stroke, August 1997