Published Online
on March 6, 2003

A more recent version of this article appeared on April 1, 2003

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Submitted on October 4, 2002
Accepted on October 11, 2002

Cuyahoga County Operation Stroke Speed of Emergency Department Evaluation and Compliance With National Institutes of Neurological Disorders and Stroke Time Targets

Irene L. Katzan MD, MS^*; Thomas M. Graber MD; Anthony J. Furlan MD; Sophia Sundararajan MD, PhD; Cathy A. Sila MD; Gary Houser; Dennis M. Landis MD; and for Cuyahoga County Operation Stroke

From the MetroHealth Medical Center (I.L.K.), Cleveland Clinic Foundation (I.L.K., A.J.F., C.A.S.), Southwest General Hospital (T.M.G.), and University Hospitals of Cleveland (S.S., D.M.L.), Cleveland, Ohio, and The Stroke Group (G.H.), Englewood Colo.

^* To whom correspondence should be addressed. E-mail: ikatzan{at}metrohealth.org.

Background and Purpose--Although the National Institutes of Neurological Disorders and Stroke (NINDS) has established time targets for the evaluation of acute stroke patients, little is known about how often these targets are met in the community. To track compliance with NINDS guidelines, Cuyahoga County Operation Stroke implemented a countywide data collection process that provides comparative reporting of hospital performance.

Methods--Data on the emergency department evaluation of stroke patients have been retrospectively collected since January 2000 by hospitals participating in Cuyahoga County Operation Stroke. All hospitals used a 1-page form that includes NINDS time target information.

Results--Median time to emergency department arrival for the 1003 patients in this cohort was 115 minutes; 382 patients (38%) arrived in <3 hours; 506 (50%) arrived in <6 hours. After arrival, median time to physician contact was 12 minutes, time to CT was 65 minutes, and time to imaging results was 105 minutes. Earlier arrival intervals after symptom onset were independently associated with shorter evaluation times. All time targets were met in patients receiving intravenous tissue plasminogen activator.

Conclusions--A countywide data collection system for acute stroke evaluation is feasible. In the Cleveland metropolitan area, time to physician contact is close to the recommended NINDS target. Time to CT and time to imaging results are substantially longer than recommended. However, there was wide variation between hospitals. The association between time to arrival, speed of evaluation, and administration of intravenous tissue plasminogen activator suggests that community physicians selectively accelerate the evaluation and management of potential thrombolysis candidates.

Key words: emergency service, hospital • guideline adherence • stroke • thrombolysis

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