Neurohospitalists Improve Door-to-Needle Times for Patients With Ischemic Stroke Receiving Intravenous tPA

I was actually incredibly disappointed in their analysis, they didn't go outside their area of expertise to find a completely newer and better way to identify ischemic vs. hemorrhagic. Try this; 1. here, 2. here, 3. here, 4. here, 5. here,   6. here, 7. here, 8. here, 9. here, 10. here, 11. here,  Don't these people keep up with research at all? And we are supposed to trust them with our lives?
http://nho.sagepub.com/content/2/4/119.full

Introduction

Patients with ischemic stroke benefit from intravenous tissue plasminogen activator (tPA), when given expeditiously.¹ Current best practice strategy identified by American Heart Association/American Stroke Association (AHA/ASA) sponsored Target: Stroke program is to achieve a door-to-needle time (DNT) ≤60 minutes for at least 50% of patients with acute ischemic stroke. However, less than one third of patients with acute ischemic stroke who receive tPA are treated within the guideline-recommended 60 minutes.² This program has identified 10 key strategies to improve DNT. These include emergency medical service prenotification, activating the stroke team with a single call, rapid acquisition and interpretation of brain imaging, use of specific protocols and tools, premixing tPA, a team-based approach, and rapid data feedback.(I bet my 11 ways would be faster and easier) Neurohospitalists are inpatient site-specific specialists mainly responsible for managing inpatient neurological conditions.³ Community neurologists, who are chiefly outpatient based and periodically cover the hospital on call, may not have time or interest to focus on inpatient quality and safety metrics on top giving optimal care to their outpatient population. Neurohospitalist model has been associated with reduced length of stay in patients with ischemic stroke.⁴ Limited data are available regarding whether inpatient neurohospitalist evaluation has an impact on DNT for intravenous thrombolysis in patients with ischemic stroke within 4.5 hours of symptom onset. We know that most inpatient neurologists are vascular neurologists.² But, there is no specific data comparing vascular neurologists and community neurologists on the quality of inpatient care. Our aim is to retrospectively compare DNT for intravenous thrombolysis in ischemic stroke between nonneurohospitalists and neurohospitalists at a single institution in the emergency department (ED).