1. Minnesota Acute Stroke System Council August 24, 2011

2. Agenda Review of progress to date Survey Results Discussion: pre-notification Discussion: acute treatment protocols Announcement: stroke initiatives structure Next Steps

3. Objectives 1.Consensus on pre-notification 2.Consensus on acute treatment protocol elements 3.Informed of organizational structure for stroke initiatives in Minnesota 4.Understand next steps for MASSC

6. Survey N=55 hospitals represented on Council (~43% of acute care hospitals in Minnesota) Responses: 20 (45%)

7. EMS Pre-Notification

8. What types of information differs? Information from ALS vs. BLS Blood sugar; medical history; last known well/time of onset; stroke scale Color (red/yellow/green) coding; “code grey” vs. “code stroke” vs. other

9. How does receiving differing information impact care?* Delays time to diagnosis Sometimes causes delay in treatment Lack of clarity may impact preparation time *Most commented more generally about how pre-notification improves lab, diagnosis, and treatment times, not about the impact of having inconsistent/varying pre- notification information)

10. Do we need to have a single protocol or standards for pre-notification?

11. Selected comments about having standards for EMS pre-notification Would be helpful to know time of onset, BP, 10-15 minute notification It’s a no-brainer! Would be helpful for all patients Need to be sensitive to resources available to various EMS systems Essential Help smaller EDs in planning Need standardization of care, standard screens Standardization would ensure appropriate assessments are done, including the most important information

12. Discussion: pre-notification Comments Standards vs. a statewide protocol What “product” should we adopt/develop? Process: working group

13. “Please list minimum elements for a diagnosis/treatment protocol” Comments “Standards” What “product” should we adopt/develop? Process: working group

14. CT availability

16. Next Steps September: transport protocol October: discussion of first drafts of products – EMS pre-notification standards; – Treatment protocol standards; – Transport protocol November: ?