This lecture will cover systems of care to streamline acute stroke management and
optimise patient outcomes. In the pre-hospital space we will discuss paramedic severity-based
triage and potential bypass to endovascular-capable hospitals including the results
of the RACECAT trial. Mobile Stroke Unit developments including results of the B_PROUD
and BEST MSU studies will be covered. In the emergency department, ambulance prenotification
and transport direct to the CT scanner are key elements that permit fast door to needle
times for thrombolysis. The concept of door-in door-out (DIDO) time relevant to primary
stroke centers that transfer patients for thrombectomy and steps to accelerate that
process will be discussed. The role of streamlined imaging protocols and avoidance
of unnecessary repeat imaging along with direct to angio suite processes will also
be discussed.
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