Systems of care from pre-hospital to emergency department

      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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