| Steps | Time | Events |
|---|---|---|
| 1 | 0 min | (2) records exact patient arrival time; (1) hands over to (2, 3); (1,2) transfers patient to CT-table; (2) measures vitals; IV access (2); Blood drawl for lab results (2); PoC Glucose and INR (2); (4) is standby. |
| 2 | +5 min | Anamnesis and neurologic examination (3); (3) Orders plain CTC; (3) informs (5); (2) takes away shoes and socks of patient; (4) makes plain CTC. |
| 3 | +10 min | (3) evaluates CT-scan, if no intracerebral blood, order CTCa; (3) communicates glucose and INR; (2) makes ECG; (4) makes CTCa; (5) is standby in ED. |
| 4 | +15 min | (3) identifies contra-indications for IVT and consults (6); If IVT: (3) gives assignment for thrombolysis preparation to (2); (3) give patient thrombolysis bolus; If CTCa: (5) evaluates CTCa and if necessary consults (7). |
| 5 | +20 min | If IVT: (2) starts thrombolysis perfusor. If CTCa: (3) evaluates lab results and contra-indications IAT; (3,5) indicate IAT; If IAT: (3) informs (6) to come; second IV access (2); (3 or 6) informs (8) and asks them to come to angio suite. |
| 6 | +25 min | If IAT: (3 or 6) calls (9) and decides necessity for help; (3 or 6) calls (10) if help by (9) is needed but is kept at OR; If help needed by (9 or 10), (11) is sent to angio suite; (3 or 6) asks (4) to arrange two extra colleagues; (3 and/or 6) leave to angio suite. |
| 7 | +30 min | If IAT: (3 or 6) organizes admission to SCU for later; (4) opens Angio Suite and informs (2) that patient may come; (11) tests anesthesia station and informs (9 or 10) to come. |
| 8 | +35 min | IF IAT: (2) transports patient to angio suite |
| 9 | +40 min | IF IAT: (3 or 6) hands over to (4); (2) transfers monitoring to (11); (2) hands over to (11). |
| 10 | +45 min | IF IAT: (3 and/or 6) monitor patient and if indicated give medication; (8) arrives at angio suite |
| 11 | +50 min | IF IAT: (4) covers patient in sterile drapes for intervention; (9 or 10) gives anesthesia. |
| 12 | +55 min | IF IVT only: Thrombolysis ready, (2) transfers patient to SCU. IF IAT: (3 and/or 6, 11) monitor patient; (8) punctures groin and performs IAT; (3) documents IAT procedure in EMR (time arrival ED ("door"), time CT, time start IVT/IAT, NIHSS, delays, etc.) |
| Steps | Time | Events |
|---|---|---|
| 1 | 0 min | (2) records exact patient arrival time; (1) hands over to (2, 3); (1,2) transfers patient to CT-table; (2) measures vitals; IV access (2); Blood drawl for lab results (2); PoC Glucose and INR (2); (4) is standby. |
| 2 | +5 min | Anamnesis and neurologic examination (3); (3) Orders plain CTC; (3) informs (5); (2) takes away shoes and socks of patient; (4) makes plain CTC. |
| 3 | +10 min | (3) evaluates CT-scan, if no intracerebral blood, order CTCa; (3) communicates glucose and INR; (2) makes ECG; (4) makes CTCa; (5) is standby in ED. |
| 4 | +15 min | (3) identifies contra-indications for IVT and consults (6); If IVT: (3) gives assignment for thrombolysis preparation to (2); (3) give patient thrombolysis bolus; If CTCa: (5) evaluates CTCa and if necessary consults (7). |
| 5 | +20 min | If IVT: (2) starts thrombolysis perfusor. If CTCa: (3) evaluates lab results and contra-indications IAT; (3,5) indicate IAT; If IAT: (3) informs (6) to come; second IV access (2); (3 or 6) informs (8) and asks them to come to angio suite. |
| 6 | +25 min | If IAT: (3 or 6) calls (9) and decides necessity for help; (3 or 6) calls (10) if help by (9) is needed but is kept at OR; If help needed by (9 or 10), (11) is sent to angio suite; (3 or 6) asks (4) to arrange two extra colleagues; (3 and/or 6) leave to angio suite. |
| 7 | +30 min | If IAT: (3 or 6) organizes admission to SCU for later; (4) opens Angio Suite and informs (2) that patient may come; (11) tests anesthesia station and informs (9 or 10) to come. |
| 8 | +35 min | IF IAT: (2) transports patient to angio suite |
| 9 | +40 min | IF IAT: (3 or 6) hands over to (4); (2) transfers monitoring to (11); (2) hands over to (11). |
| 10 | +45 min | IF IAT: (3 and/or 6) monitor patient and if indicated give medication; (8) arrives at angio suite |
| 11 | +50 min | IF IAT: (4) covers patient in sterile drapes for intervention; (9 or 10) gives anesthesia. |
| 12 | +55 min | IF IVT only: Thrombolysis ready, (2) transfers patient to SCU. IF IAT: (3 and/or 6, 11) monitor patient; (8) punctures groin and performs IAT; (3) documents IAT procedure in EMR (time arrival ED ("door"), time CT, time start IVT/IAT, NIHSS, delays, etc.) |
Abbreviations: CT: Cat Scan; CTCa: CT scan of the carotid arteries with contrast; ECG: electrocardiogram (12 leads); IVT/IAT: intravenous thrombolysis/intra-arterial thrombectomy; PoC: point-of-Care lab determinations such as INR, blood glucose level, hemoglobin level, blood gas, and so on; NIHSS: National Institute of Health Stroke Scale; point-of-Care lab determination such as INR, blood glucose level, hemoglobin level, blood gas, and so on.
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