Skip Navigation Links

MGH Emergency Department Acute Stroke Protocol for Thrombolysis (IV/IA)

Prior to making any medical decisions, please view our disclaimer.

This protocol was developed and approved by the multidisciplinary Acute Stroke Quality Taskforce and outlines the major responsibilities for the urgent evaluation and treatment of acute stroke patients who present to the ED.

Please refer to other guidelines for the management of inpatients with acute stroke symptoms, or those who present between 6 to 12 hrs after onset of symptoms.

Protocol Activation

Activate the Acute Stroke Protocol for all patients who were Last Seen Well less than 8 hours before ED arrival with acute neurological symptoms. In cases with fluctuating symptoms, those with complex issues, or who are possible research subjects, the protocol should also be activated.

NIH and DPH Recommended Time Targets

The following chart, which outlines the Time Targets mentioned in the Primary Stroke Service Regulations, is included to help hospitals assess the timeliness of activities related to stroke evaluation and diagnosis.

Some of the activities listed below will occur concurrently, and the Department of Health recognizes actual individual timeframes may vary, however the goal for the initiation of IV t-PA remains at one hour from the time of patient arrival in the ED.

Emergency Department Process Measure Assessment Tool
Activity Time Targets
Time from patient arrival at ED to notification of Acute Stroke Team (AST), i.e., making the call to the team within 15 minutes of arrival
Time from notification of AST to response of team member by phone, video or at patient bedside to assess patient as appropriate within 15 minutes of being called
Time from order of CT scan or MRI scan to performance within 25 minutes of order being written
Time from completion of CT scan or MRI scan to interpretation by physician within 20 minutes of completion of scan
Time from order of chest X-Ray, if indicated, to performance through completion of chest X-Ray and interpretation within 45 minutes of being ordered
Time from order of ECG to performance through completion of ECG and interpretation within 45 minutes of being ordered
Time from order of lab tests to completion of tests, report of results, and interpretation within 45 minutes of being ordered
ED door-to-needle time for IV thrombolytic (t-PA) treatment within 60 minutes of patient arrival in ED
Time from order of neurosurgical evaluation to start of evaluation; includes transfer to another hospital for such evaluation, if applicable within 2 hours of being deemed clinically necessary
Neurosurgical intervention as needed urgently

The protocol is divided into the following sections:

Thank you for e-mailing this page.

Your Name 
Your E-mail 
Friend's Name 
Friend's E-mail 

Thank you for your providing feedback. Your comments will be responded to within an appropriate time frame.

Your Name 

Text Size: A A A

Bookmarking Tools

Save & Share this webpage

Digg Reddit Google Yahoo

In the News

The MGH Neurology Department placed 4th in US News Neurology / NeuroSurgery rankings for 2014-15.

Educational Video

Still from the Stroke Evaluation simulation

This video simulation of an Emergency stroke evaluation illustrates the care of patients with acute stroke by the MGH Acute Stroke team.