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
Protocols / Tools
Initial Assessment at Triage:
- Stroke Triage Education ACT-FAST
- t-PA EVT Process Algorithm (ED)
- Toronto Stroke Networks “Walk in protocols”:
- Role of the RN
- Role of Physician
- Role of Unit Clerk in ED
- Walk In Code Stroke Protocol Algorithm: 24/7
- Code Stroke Assessment and Transfer Record
- Walk In Code Stroke Protocol: Patient in ED of Non-Regional Stroke Centre
- Stroke Bypass/Repatriation and Walk-In Protocol Reporting Form
- Code Stroke ED Contact Information
Consultation/Referral via CritiCall Ontario:
- Provincial EVT Referral and Transport Process (June 2019)
- Provincial EVT Referral and Transport Process (June 2019) – Flowchart
- Provincial EVT Referral Mapping for CritiCall Ontario
- CCSO Repatriation Guide 2014
- CCSO Repatriation Guide Addendum 2019
- Life or Limb Policy (Dec 2013)
- CritiCall EVT Help Sheet
- Ontario Telestroke Program Referral Worksheet 24h (February 2021)
- Ontario Telestroke Program, Decision Algorithm 24hr (September 2022) (EN)
Ontario Telestroke Program, Decision Algorithm 24hr (September 2022) (FR) - Ontario Telestroke Program, Consult Note Documentation Policy
- EVT R2 Activation Guidance Document (June 2022)
- Guidance for Determining the need for a Medical Escort Requirements (June 2023)
Presentations / Videos
Websites
Acute Stroke Protocol - EVT Centre
Protocols / Tools
Presentations / Videos
There are currently no resources for this item.
Websites
- Modified Rankin Scale (MRS).
- ASPECT in stroke (currently unavailable).
Articles
- There are currently no resources for this item