Improved door-to-needle times and neurologic outcomes when IV tissue plasminogen activator is administered by emergency physicians with advanced neuroscience training

Am J Emerg Med. 2015 Feb;33(2):234-7. doi: 10.1016/j.ajem.2014.11.025. Epub 2014 Nov 28.


Background: The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.

Methods: This is a retrospective study evaluating DTN time, discharge outcomes, and discharge location in acute stroke patients who received IV tPA at our comprehensive stroke center. These outcome measures were compared between patients who were evaluated and treated in our neuro ED to those treated in our main ED.

Results: From 2012 to 2014, 67 acute stroke patients received IV tPA in our ED. Thirty-five patients were evaluated in the neuro ED, and 32, in the main ED. Average DTN times were significantly faster in the neuro ED at 35 minutes, compared to main ED DTN times of 83 minutes. Discharge NIHSS score was significantly lower, and more patients were discharged to home in the neuro ED group compared to the main ED group.

Conclusions: Trained neuro ED physicians can safely give IV tPA independently for stroke patients with improved DTN times, lower discharge NIHSS, and higher likelihood of being discharged to home compared to the main ED physicians who used teleneurology consultation. This suggests utility in training emergency medicine physicians to administer tPA independently based on clinical practice guidelines.

MeSH terms

  • Aged
  • Emergency Medicine / education
  • Emergency Medicine / standards
  • Emergency Medicine / statistics & numerical data
  • Emergency Service, Hospital / standards
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosciences / education*
  • Quality Improvement* / organization & administration
  • Quality Improvement* / statistics & numerical data
  • Retrospective Studies
  • Stroke / diagnosis
  • Stroke / drug therapy*
  • Time Factors
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome
  • Workforce


  • Tissue Plasminogen Activator