Educate stroke patients to come in early

No matter how short you get your door-to-drug times, most patients won't be candidates for tissue plasminogen activator (t-PA), which is the only clot-busting medication approved by the Food and Drug Administration. The reason? Most stroke patients arrive at the ED too late, according to two recently published studies.

In one study, just 30% of stroke patients arrived within three hours of the onset of their symptoms.1 In another study, only 2% of 214 stroke patients screened were eligible for treatment, with 95 of them excluded only because they arrived too late.2

"Educating the public about stroke symptoms is extremely important, so that they will present to the ED within the time frame for treatment," says Patricia Kunz Howard, RN, MSN, CCRN, CEN, EMS training coordinator for the Lexington (KY) Fayette Urban County Government Division of Fire and Emergency Services and former ED director and stroke team coordinator at Central Baptist Hospital, also in Lexington.

Give them signs and symptoms

Patients should be informed of the signs and symptoms of stroke, the need to call 911 to access care, and the available stroke centers in the area, says Nanette H. Hock, RN, MSN, program coordinator for the Stanford Stroke Center in Palo Alto, CA.

"When stroke symptoms are evolving or resolving, stress the need to call 911 regardless of symptom resolution," says Hock. "Explain that there is no medication that one can take at home to prevent or stop an evolving stroke."

For primary or secondary stroke prevention in the presence of risk factors such as heart disease, high cholesterol, and diabetes, the patients should contact their physicians for medications or other interventions, advises Hock.

ED nurses have a variety of educational tools

Education can be done by the ED nurses in a variety of ways, says Howard. Here are some ways to educate patients, she suggests:

• Conduct stroke screenings in the community.

• Give short presentations to community civic or religious groups.

• Put up posters and stroke brochures in the waiting room.

• Survey visitors and patients in the ED waiting room to learn more about the community's knowledge of stroke.

• Include a preprinted stroke information section with discharge instructions.

• Hold a patient education class for the community about stroke signs and symptoms.


1. Kothari R, Jauch E, Broderick J, et al. Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med 1999; 33:3-8.

2. O'Connor RE, McGraw P, Edelsohn J. Thrombolytic therapy for acute ischemic stroke: Why the majority of patients remain ineligible for treatment. Ann Emerg Med 1999; 33:9-14.