Get stroke patients CT scans more quickly

Every part of the process in stroke care — from the time the patient begins to have symptoms to the time treatment is initiated — is constantly examined for ways to cut minutes, reports Sharon Pulver, MSN, RN, CEN, network stroke coordinator for the SSM Neurosciences Institute in St. Louis, MO.

"Time is of the essence in stroke treatment," she says, adding that according to the American Stroke Association, one minute of brain ischemia can kill two million nerve cells and 14 billion synapses. The ED set a door-to-drug goal of 60 minutes or less, she reports, and goals for door-to-CT within 25 minutes and door-to-report in 45 minutes. These steps were taken:

• Protocols were established and everyone involved was educated.

"A team approach based on standardized stroke protocols has proven to be effective in reducing time to treatment," says Pulver.

• Emergency medical services (EMS) is allowed to call a "Code Stroke" from the field.

EMS requires education, says Pulver, so that they can identify signs and symptoms of stroke. "When they call a stroke in the field, we begin the process in the ED — a ready bed, CT notified, and registration notified," she says. "If possible, we take the patient directly to CT after a brief check for life-threatening symptoms." (See clinical tip, below, on giving blood tubes to EMS.)

Registration may use a computer on wheels and register the patient en route to CT, says Pulver, or may do a "quick registration" and complete it when the patient returns to the ED.

• The radiologist calls the ED physician with the report on all Code Strokes.

Document the time of the call on the official read, advises Pulver, which allows data to be easily collected for process improvement. "It also allows the physician to be seeing patients while the CT is being read, instead of hovering over a fax machine or the computer for results," she says.

• Include CT technicians on your stroke team.

"Review the data at every meeting. It keeps everyone on track," says Pulver. "Competition drives down times."


For more information about reducing delays to CT scan for stroke patients, contact:

Sharon Pulver, MSN, RN, CEN, Network Stroke Coordinator, SSM Neurosciences Institute, St. Louis, MO. E-mail:

Clinical Tip

Give EMS blood tubes: Speed CT scans

To eliminate a step that could delay an ED stroke patient from receiving a CT scan, supply emergency medical services with a packet of your hospital's blood tubes, recommends Sharon Pulver, MSN, RN, CEN, network stroke coordinator for the SSM Neurosciences Institute in St. Louis, MO.

"As soon as they start the IV, they can draw the labs and hand them off to the nurse. The labs can be processed as the patient is in CT," she explains. "Many times, it is the wait for the labs to be drawn that delays the trip to CT."