Resident-Based Acute Stroke Protocol Is Expeditious and Safe

Background and Purpose-The decision to administer tPA to acute stroke patients is frequently made by stroke attendings or fellows, but placing residents in this position may make tPA delivery more efficient. Methods-Beginning in 2004, we instituted a resident-based acute stroke protocol placing neurology residents in decision-making roles. Time-intervals, symptomatic hemorrhage rate, and discharge locations were prospectively collected and compared between two epochs, before and after 2004. Results-59 acute ischemic stroke patients were treated with tPA before protocol initiation (1998 to 2002), while 113 patients were treated after protocol initiation (2004 to 2007). The average door-to-needle and onset-to-needle times were significantly shorter after initiation of the resident-based protocol (81 versus 60 minutes [P<0.001] and 138 versus 126 minutes [P<0.05]), respectively. Symptomatic hemorrhage rate (5.1% versus 3.5%) and favorable discharge location (68% versus 76%) did not differ between the two time periods. Conclusion-A resident-driven tPA protocol, with formal training and quality control, is safe and efficient. (Stroke. 2009; 40:1512-1514.)