1. DISCLOSURE INFORMATION: Target: Stroke is an initiative provided by the American Heart Association/American Stroke Association. The University of California, Regents receive funding for Dr Saver’s services as a scientific consultant regarding trial design and conduct to Covidien, CoAxia, BrainsGate, Genervon, and Grifols. Dr Saver is an investigator in the NIH FAST-MAG, MR RESCUE, CLEARER, and IMS 3 multicenter clinical trials for which the UC Regents receive payments on the basis of clinical trial performance; has served as an unpaid site investigator in multicenter trials run by Lundbeck and Covidien for which the UC Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled; and is an employee of the University of California, which holds patent rights in coil retrievers. Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Medscape Cardiology; Board of Directors: Boston VA Research Institute, Society of Chest Pain Centers; Chair: American Heart Association Get With The Guidelines Science Subcommittee; Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Duke Clinical Research Institute (clinical trial steering committees), Slack Publications (Chief Medical Editor, Cardiology Today Intervention), WebMD (CME steering committees); Other: Senior Associate Editor, Journal of Invasive Cardiology; Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda. The benefits of intravenous tissue- plasminogen activator (IV tPA) in acute ischemic stroke are time-dependent National guidelines recommend door-to- needle time ≤60 minutes. However, fewer than 1/3 of patients treated with IV tPA are treated within guideline recommended door- to-needle time Several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are utilizing these strategies has not been well studied. Background Methods Target: Stroke is a national initiative sponsored by the AHA/ASA to assist hospitals in increasing the proportion of IV tPA-treated patients who achieve guideline- recommended door-to-needle within 60 mins We surveyed 350 hospitals joining Target: Stroke regarding their baseline use of strategies to reduce door-to-needle time prior to the initiation of Target Stroke The survey was developed based on literature review and expert consensus for strategies identified as being associated with shorter door-to-needle times After excluding 46 hospitals that did not give tPA or reported invalid treatment timelines, the final study population consisted of 5,460 patients from 304 hospitals between 1/2008- 2/2010 Results Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey Gregg C. Fonarow 1 ; Eric E. Smith 2 ; Xin Zhao 3 ; Eric D. Peterson 3 ; Ying Xian 3 ; DaiWai M. Olson 3,4 ; Adrian F. Hernandez 3 ; Deepak L. Bhatt 5 ; Jeffrey L. Saver 6 ; Lee H. Schwamm 7 1 Division of Cardiology, University of California, Los Angeles, CA; 2 Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; 3 Duke Clinical Research Institute, Durham, NC; 4 University of Texas Southwestern Medical Center, Dalls, TX; 5 VA Boston Healthcare System, Boston, MA; 6 Department of Neurology, University of California, Los Angeles, CA; 7 Department of Neurology, Massachusetts General Hospital, Boston, MA Hospital Characteristics Strategies Reported by Hospitals to Improve Acute Ischemic Stroke Evaluation and Treatment Times Conclusions While most US hospitals participating in this survey report use of the strategies to improve the timeliness of tPA administration for acute ischemic stroke, significant variation exists Further research is needed to understand which of these strategies are most effective in improving acute ischemic stroke care LevelN=304 (% or value) Hospital type, academic50% Annual ischemic stroke volume, median (IQR) 163 (106-247) tPA treated patients per year, median (IQR) 10 (6-17) Door-to-needle time, median (IQR)79 (71-89) min Initiating or revising strategies to reduce door-to-needle time in the prior 2 years 70% Planned to have a dedicated team focused on reducing door-to-needle time 92% StrategiesAll of the timeSome of the timeNone of the timeUnable to determine EMS Prenotification52.3%42.4%3.6%1.6% Rapid Triage and Stroke Team Notification 68.8%23.4%6.6%1.3% Single Call Activation System62.5%9.5%25.0%3.0% In-House Stroke Expertise 24X779.0%14.8%5.3%1.0% StrategiesYesNo Rapid Brain Imaging Protocol91.8%8.2% CT Scanner Located in Emergency Department 42.1%57.9% Rapid Laboratory Testing Protocol93.1%6.9% Ischemic Stroke Critical Pathway56.6%43.4% tPA Administration Protocol89.8%10.2% tPA Stored in Emergency Department 62.2%37.8% Pre-Mixing of tPA83.9%16.2% Interdisciplinary Stroke Team for Performance Improvement 93.8%6.3% Regular Feedback on DTN Times Provided 72.4%27.6% Distribution of Door-to-Needle Times among 5,460 Patients from 304 Hospitals in Target: Stroke