Section 2: ED Assessment and Triage

Patients require immediate evaluation when presenting to the Emergency Department (ED) with a suspected stroke or transient ischemic attack (TIA). It is impossible to reliably differentiate infarct from hemorrhage by clinical examination alone. Brain imaging is required to guide management, including the selection of time-sensitive acute stroke treatments.

In 2016, the Heart and Stroke Foundation released the Key Quality Indicators for Stroke Care. National benchmarks for ED assessment and triage include:

  • Door to CT/CTA: ≤ 15 minutes
  • Stroke onset to tPA administration: ≤ 4.5 hours
  • Door to Needle/tPA: ≤ 30 minutes
  • Door to Groin Puncture: ≤ 60 minutes
  • Door to Revascularization: ≤ 90 minutes

Referring Centre Door In to Referring Centre ED Out: ≤ 45 minutes

As of Feb 8th 2021 CorHealth Ontario’s Hyperacute Stroke Care Steering Committee endorsed a provincial move toward adoption of a 24 hour treatment window for Endovascular Thrombectomy for patients presenting with acute ischemic stroke. This reflects current best practice and Regional Stroke Networks are encouraged to work toward this implementation as a standard of care with all relevant acute providers in their stroke regions. Resources to support implementation for Telestroke hospitals can be found below (under Consultation/Referral via CritiCall Ontario).

Acute Stroke Protocol - Referring tPA Centre

Acute Stroke Protocol - EVT Centre

Non-tPA Hospitals