{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T08:24:01Z","timestamp":1772439841699,"version":"3.50.1"},"reference-count":118,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local\/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.<\/jats:p>","DOI":"10.3390\/ijerph192316357","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T02:18:48Z","timestamp":1670379528000},"page":"16357","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review"],"prefix":"10.3390","volume":"19","author":[{"given":"Ana","family":"Botelho","sequence":"first","affiliation":[{"name":"Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal"},{"name":"Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal"},{"name":"Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal"}]},{"given":"Jonathan","family":"Rios","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal"}]},{"given":"Ana Paula","family":"Fidalgo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5604-3339","authenticated-orcid":false,"given":"Eug\u00e9nia","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1502-3534","authenticated-orcid":false,"given":"Hip\u00f3lito","family":"Nzwalo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal"},{"name":"Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal"},{"name":"Algarve Biomedical Research Institute, 8005-139 Faro, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/S1473-3099(17)30483-8","article-title":"The global burden of scabies: A cross-sectional analysis from the Global Burden of Disease Study 2015","volume":"17","author":"Karimkhani","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"The ATLANTIS, ECASS, and NINDS rt-PA Study Group Investigators (2004). Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet, 363, 768\u2013774.","DOI":"10.1016\/S0140-6736(04)15692-4"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1001\/jama.2016.13647","article-title":"Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: Ameta-analysis","volume":"316","author":"Saver","year":"2016","journal-title":"J. Am. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/2396987318786023","article-title":"Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries","volume":"4","author":"Abilleira","year":"2019","journal-title":"Eur. Stroke J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1161\/01.STR.0000069164.91268.99","article-title":"Pre-and In-Hospital Delays From Stroke Onset to Intra-arterial Thrombolysis","volume":"34","author":"Nedeltchev","year":"2003","journal-title":"Stroke"},{"key":"ref_7","unstructured":"Wells, G.A., Wells, G., Shea, B., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., Tugwell, P., and Ga, S.W. (2000). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses, Ottawa Hospital Research Institute. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105426","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105426","article-title":"Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke","volume":"30","author":"Seo","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ungerer, M.N., Busetto, L., Begli, N.H., Riehle, K., Regula, J., and Gumbinger, C. (2020). Factors affecting prehospital delay in rural and urban patients with stroke: A prospective survey-based study in Southwest Germany. BMC Neurol., 20.","DOI":"10.1186\/s12883-020-01999-4"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"105284","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105284","article-title":"Pre-Hospital Delay in Patients with Acute Ischemic Stroke in a Multicenter Stroke Registry: K-PLUS","volume":"29","author":"Nagao","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Kielkopf, M., Meinel, T., Kaesmacher, J., Fischer, U., Arnold, M., Heldner, M., Seiffge, D., Mordasini, P., Dobrocky, T., and Piechowiak, E. (2020). Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082376"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1136\/svn-2019-000277","article-title":"Emergency medical services use and its association with acute ischaemic stroke evaluation and treatment in Singapore","volume":"5","author":"Xu","year":"2020","journal-title":"Stroke Vasc. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105341","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105341","article-title":"Expanded Indication for Recombinant Tissue Plasminogen Activator from 3 to 4.5 h after Onset of Stroke in Japan","volume":"29","author":"Miyamoto","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"104761","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104761","article-title":"Utilization of Intravenous Tissue Plasminogen Activator and Reasons for Nonuse in Acute Ischemic Stroke in Saudi Arabia","volume":"29","author":"Tarawneh","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Soto-C\u00e1mara, R., Gonz\u00e1lez-Santos, J., Gonz\u00e1lez-Bernal, J., Mart\u00edn-Santidrian, A., Cubo, E., and Trejo-Gabriel-Gal\u00e1n, J.M. (2019). Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101712"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e013101","DOI":"10.1161\/JAHA.119.013101","article-title":"Reasons for Prehospital Delay in Acute Ischemic Stroke","volume":"8","author":"Fladt","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1080\/02699052.2019.1641226","article-title":"Factors associated with delayed presentation at the emergency department in patients with acute ischemic stroke","volume":"33","author":"Dimitriou","year":"2019","journal-title":"Brain Inj."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Nepal, G., Yadav, J.K., Basnet, B., Shrestha, T.M., Kharel, G., and Ojha, R. (2019). Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal. BMC Neurol., 19.","DOI":"10.1186\/s12883-019-1378-3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"104331","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104331","article-title":"Contribution of Onset-to-Alarm Time to Prehospital Delay in Patients with Ischemic Stroke","volume":"28","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1136\/postgradmedj-2019-136413","article-title":"Trends in acute stroke presentations to an emergency department: Implications for specific communities in accessing acute stroke care services","volume":"95","author":"Bhaskar","year":"2019","journal-title":"Postgrad. Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e15422","DOI":"10.1097\/MD.0000000000015422","article-title":"Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke: A retrospective cohort study","volume":"98","author":"Chai","year":"2019","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.auec.2019.01.008","article-title":"Prehospital and hospital delays for stroke patients treated with thrombolysis: A retrospective study from mixed rural\u2013urban area in Northern Finland","volume":"22","author":"Varjoranta","year":"2019","journal-title":"Australas. Emerg. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1161\/STROKEAHA.118.024232","article-title":"Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke: Findings From the China Stroke Center Alliance","volume":"50","author":"Gu","year":"2019","journal-title":"Stroke"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1161\/STROKEAHA.119.027843","article-title":"Melbourne mobile stroke unit and reperfusion therapy: Greater clinical impact of thrombectomy than thrombolysis","volume":"51","author":"Zhao","year":"2020","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e013529","DOI":"10.1161\/JAHA.119.013529","article-title":"Geographic Analysis of Mobile Stroke Unit Treatment in a Dense Urban Area: The New York City METRONOME Registry","volume":"8","author":"Kummer","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jns.2018.07.009","article-title":"In-hospital delays to stroke thrombolysis: Out of hours versus regular hours and reduction in treatment times through the creation of a 24\/7 mobile thrombolysis team","volume":"392","author":"Hebant","year":"2018","journal-title":"J. Neurol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1212\/WNL.0000000000003786","article-title":"Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis","volume":"88","author":"Taqui","year":"2017","journal-title":"Neurology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1161\/STROKEAHA.116.014270","article-title":"In-Transit Telemedicine Speeds Ischemic Stroke Treatment: Preliminary Results","volume":"47","author":"Belt","year":"2016","journal-title":"Stroke"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1161\/STROKEAHA.116.013057","article-title":"Influence of Distance to Scene on Time to Thrombolysis in a Specialized Stroke Ambulance","volume":"47","author":"Koch","year":"2016","journal-title":"Stroke"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1111\/jon.12276","article-title":"A Mobile Stroke Treatment Unit for Field Triage of Patients for Intraarterial Revascularization Therapy","volume":"25","author":"Cerejo","year":"2015","journal-title":"J. Neuroimaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1001\/jamaneurol.2015.3849","article-title":"Telemedicine in prehospital stroke evaluation and thrombolysis taking stroke treatment to the doorstep","volume":"73","author":"Itrat","year":"2016","journal-title":"JAMA Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1161\/STROKEAHA.114.008159","article-title":"Improved prehospital triage of patients with stroke in a specialized stroke ambulance results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study","volume":"46","author":"Wendt","year":"2015","journal-title":"Stroke"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"105319","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105319","article-title":"Mobile App Based Strategy Improves Door-to-Needle Time in the Treatment of Acute Ischemic Stroke","volume":"29","author":"Noone","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"104897","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104897","article-title":"Factors Associated with Pre-Hospital Delay and Intravenous Thrombolysis in China","volume":"29","author":"Zhu","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.12.009","article-title":"Late Hospital Arrival for Thrombolysis after Stroke in Southern Portugal: Who Is at Risk?","volume":"28","author":"Sobral","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2668","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.07.013","article-title":"Older Stroke Patients with High Stroke Scores Have Delayed Door-To-Needle Times","volume":"25","author":"Birnbaum","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.02.011","article-title":"Impact of Prehospital Intervention on Delay Time to Thrombolytic Therapy in a Stroke Center with a Systemized Stroke Code Program","volume":"25","author":"Kim","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.10.026","article-title":"Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati\/Northern Kentucky Stroke Study","volume":"25","author":"Madsen","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.annemergmed.2018.08.435","article-title":"Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review","volume":"73","author":"Hassankhani","year":"2019","journal-title":"Ann. Emerg. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"205031211877671","DOI":"10.1177\/2050312118776719","article-title":"Factors associated with late arrival of acute stroke patients to emergency department in Saudi Arabia","volume":"6","author":"Mohammad","year":"2018","journal-title":"SAGE Open Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"NP19","DOI":"10.1177\/1747493018790130","article-title":"Onset-to-alarm time in patients with acute stroke: Results from a Mexican population","volume":"13","year":"2018","journal-title":"Int. J. Stroke"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e004512","DOI":"10.1161\/CIRCOUTCOMES.117.004512","article-title":"Comparison of Acute Ischemic Stroke Care and Outcomes between Comprehensive Stroke Centers and Primary Stroke Centers in the United States","volume":"11","author":"Man","year":"2018","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.12.024","article-title":"The Effect of Being Found with Stroke Symptoms on Predictors of Hospital Arrival","volume":"27","author":"Springer","year":"2018","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"125","DOI":"10.18865\/ed.27.2.125","article-title":"Race-ethnic disparities in hospital arrival time after ischemic stroke","volume":"27","author":"Springer","year":"2017","journal-title":"Ethn. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.01.019","article-title":"Temporal Trends in Intravenous Thrombolysis in Acute Ischemic Stroke: Experience from a Tertiary Care Center in India","volume":"26","author":"Khurana","year":"2017","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1161\/STROKEAHA.116.015131","article-title":"Door-to-imaging time for acute stroke patients is adversely affected by emergency department crowding","volume":"48","author":"Reznek","year":"2017","journal-title":"Stroke"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e005903","DOI":"10.1161\/CIRCOUTCOMES.119.005903","article-title":"Trends in Telestroke Care Delivery: A 15-Year Experience of an Academic Hub and Its Network of Spokes","volume":"13","author":"Sharma","year":"2020","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_48","first-page":"50","article-title":"Trends in New Zealand stroke thrombolysis treatment rates","volume":"130","author":"Liu","year":"2017","journal-title":"N. Z. Med. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1111\/ijs.12484","article-title":"Oxford Vascular Study Sustained impact of UK FAST-test public education on response to stroke: A population-based time-series study","volume":"10","author":"Wolters","year":"2015","journal-title":"Int. J. Stroke"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1007\/s10072-019-03901-8","article-title":"New evidence-based A1, A2, A3 alarm time zones for transferring thrombolysed patients to hyper-acute stroke units: Faster is better","volume":"40","author":"Han","year":"2019","journal-title":"Neurol. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Zinkstok, S.M., Beenen, L.F., Luitse, J.S., Majoie, C.B., Nederkoorn, P.J., and Roos, Y.B. (2016). Thrombolysis in stroke within 30 minutes: Results of the acute brain care intervention study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166668"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1177\/1747493019840939","article-title":"Evaluation of the Swedish National Stroke Campaign: A population-based time-series study","volume":"14","author":"Nordanstig","year":"2019","journal-title":"Int. J. Stroke"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.02.026","article-title":"Mass media intervention in western Norway aimed at improving public recognition of stroke, emergency response, and acute treatment","volume":"25","author":"Advani","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2886","DOI":"10.1161\/STROKEAHA.115.010264","article-title":"Routing ambulances to designated centers increases access to stroke center care and enrollment in prehospital research","volume":"46","author":"Sanossian","year":"2015","journal-title":"Stroke"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"105220","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105220","article-title":"The Effect of a County Prehospital FAST-ED Initiative on Endovascular Treatment Times","volume":"29","author":"Rynor","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"104689","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104689","article-title":"Time Intervals for Direct Versus Transfer Cases of Thrombectomy for Stroke in a Primarily Rural System of Care","volume":"29","author":"Mashni","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1159\/000499112","article-title":"Direct admission versus secondary transfer for acute stroke patients treated with intravenous thrombolysis and thrombectomy: Insights from the endovascular treatment in ischemic stroke registry","volume":"47","author":"Blanc","year":"2019","journal-title":"Cerebrovasc. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.09.051","article-title":"A Regional Network Organization for Thrombectomy for Acute Ischemic Stroke in the Anterior Circulation; Timing, Safety, and Effectiveness","volume":"28","author":"Mourand","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1161\/CIRCULATIONAHA.118.036701","article-title":"Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals","volume":"139","author":"Menon","year":"2019","journal-title":"Circulation"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jocn.2015.06.038","article-title":"Direct admission to stroke centers reduces treatment delay and improves clinical outcome after intravenous thrombolysis","volume":"27","author":"Kim","year":"2016","journal-title":"J. Clin. Neurosci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"104423","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104423","article-title":"Prehospital and Emergency Department-Focused Mission Protocol Improves Thrombolysis Metrics for Suspected Acute Stroke Patients","volume":"28","author":"Madhok","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"105433","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105433","article-title":"Improving Acute In-Hospital Stroke Care by Reorganization of an In-Hospital Stroke Code Protocol","volume":"30","author":"Kawano","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.12.002","article-title":"Talk About Thrombolysis. Regular Case-Based Discussions of Stroke Thrombolysis Improve Door-to-Needle Time by 20%","volume":"28","author":"Klingner","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.annemergmed.2018.07.019","article-title":"Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians","volume":"73","author":"Kuusisto","year":"2019","journal-title":"Ann. Emerg. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e004981","DOI":"10.1161\/CIRCOUTCOMES.118.004981","article-title":"A Decade of Improvement in Door-to-Needle Time Among Acute Ischemic Stroke Patients, 2008 to 2017","volume":"11","author":"Tong","year":"2018","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1159\/000487965","article-title":"A Network-Wide Stroke Team Program Reduces Time to Treatment for Endovascular Stroke Therapy in a Regional Stroke-Network","volume":"45","author":"Bohmann","year":"2018","journal-title":"Cerebrovasc. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jen.2016.10.006","article-title":"Improving Access to Stroke Care in the Rural Setting: The Journey to Acute Stroke Ready Designation","volume":"43","author":"Slivinski","year":"2017","journal-title":"J. Emerg. Nurs."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e003227","DOI":"10.1161\/CIRCOUTCOMES.116.003227","article-title":"Use of Strategies to Improve Door-to-Needle Times with Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice: Findings from Target: Stroke","volume":"10","author":"Xian","year":"2017","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1136\/neurintsurg-2016-012324","article-title":"Streamlining door to recanalization processes in endovascular stroke therapy","volume":"9","author":"Aghaebrahim","year":"2017","journal-title":"J. Neurointerv. Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1161\/CIRCOUTCOMES.116.003222","article-title":"Regional learning collaboratives produce rapid and sustainable improvements in stroke thrombolysis times","volume":"9","author":"Prabhakaran","year":"2016","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.05.023","article-title":"The Stroke Chronometer\u2014A New Strategy to Reduce Door-to-Needle Time","volume":"25","author":"Marto","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.03.047","article-title":"Stroke Thrombolysis Protocol Shortens \u201cDoor-to-Needle Time\u201d and Improves Outcomes\u2014Experience at a Tertiary Care Center in Qatar","volume":"25","author":"Ibrahim","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Huang, Q., Song, H.Q., Ji, X.M., Cheng, W.Y., Feng, J., Wu, J., and Ma, Q.F. (2016). Generalization of the right acute stroke prevention strategies in reducing in-hospital delays. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154972"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s13246-016-0442-1","article-title":"Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization","volume":"39","author":"Liang","year":"2016","journal-title":"Australas. Phys. Eng. Sci. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.12.001","article-title":"Stop Stroke\u00a9 Acute Care Coordination Medical Application: A Brief Report on Postimplementation Performance at a Primary Stroke Center","volume":"25","author":"Dickson","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1136\/neurintsurg-2015-012219","article-title":"The pit-crew model for improving door-to-needle times in endovascular stroke therapy: A Six-Sigma project","volume":"8","author":"Rai","year":"2016","journal-title":"J. Neurointerv. Surg."},{"key":"ref_77","first-page":"1656212","article-title":"Simple In-Hospital Interventions to Reduce Door-to-CT Time in Acute Stroke","volume":"2016","author":"Taheraghdam","year":"2016","journal-title":"Int. J. Vasc. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2829","DOI":"10.1161\/STROKEAHA.119.025838","article-title":"Door-in-door-out time of 60 minutes for stroke with emergent large vessel occlusion at a primary stroke center","volume":"50","author":"Choi","year":"2019","journal-title":"Stroke"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.nrl.2014.12.004","article-title":"Identificaci\u00f3n de los factores que influyen en el retraso intrahospitalario del inicio de tromb\u00f3lisis intravenosa en el ictus agudo en un hospital terciario","volume":"31","year":"2016","journal-title":"Neurologia"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1136\/neurintsurg-2019-014890","article-title":"An interdisciplinary approach to inhospital stroke improves stroke detection and treatment time","volume":"11","author":"Manners","year":"2019","journal-title":"J. Neurointerv. Surg."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.01.005","article-title":"Improvement in Door-to-Needle Time in Patients with Acute Ischemic Stroke via a Simple Stroke Activation Protocol","volume":"27","author":"Tan","year":"2018","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1161\/STROKEAHA.117.018335","article-title":"Improving access to thrombolysis and inhospital management times in ischemic stroke a stepped-wedge randomized trial","volume":"49","author":"Haesebaert","year":"2018","journal-title":"Stroke"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1161\/STROKEAHA.117.018413","article-title":"Novel telestroke program improves thrombolysis for acute stroke across 21 hospitals of an integrated healthcare system","volume":"49","author":"Klingman","year":"2018","journal-title":"Stroke"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.03.004","article-title":"Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital","volume":"26","author":"Threlkeld","year":"2017","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.neurol.2016.12.032","article-title":"Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening","volume":"173","author":"Sablot","year":"2017","journal-title":"Rev. Neurol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e003242","DOI":"10.1161\/CIRCOUTCOMES.116.003242","article-title":"Improving Door-to-Needle Times for Acute Ischemic Stroke: Effect of Rapid Patient Registration, Moving Directly to Computed Tomography, and Giving Alteplase at the Computed Tomography Scanner","volume":"10","author":"Kamal","year":"2017","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"104477","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104477","article-title":"Is Door-to-Needle Time Reduced for Emergency Medical Services Transported Stroke Patients Routed Directly to the Computed Tomography Scanner on Emergency Department Arrival?","volume":"29","author":"Sloane","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_88","first-page":"385","article-title":"Implementaci\u00f3n de un protocolo de transferencia directa y movilizaci\u00f3n del equipo de ictus para reducir los tiempos de reperfusi\u00f3n","volume":"31","year":"2019","journal-title":"Emergencias"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1017\/cjn.2018.368","article-title":"Reducing door-to-needle times for ischaemic stroke to a median of 30 minutes at a community hospital","volume":"46","author":"Kamal","year":"2019","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10903127.2017.1356410","article-title":"Observational Multicenter Study of a Direct-to-CT Protocol for EMS-transported Patients with Suspected Stroke","volume":"22","author":"Cone","year":"2018","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.07.053","article-title":"Long-Term Impact of Implementation of a Stroke Protocol on Door-to-Needle Time in the Administration of Intravenous Tissue Plasminogen Activator","volume":"26","author":"Hillen","year":"2017","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jocn.2014.05.047","article-title":"Trends in yield of a code stroke program for enhancing thrombolysis","volume":"22","author":"Kim","year":"2015","journal-title":"J. Clin. Neurosci."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ajem.2019.158398","article-title":"Impact of CT scanner location on door to imaging time for emergency department stroke evaluation","volume":"38","author":"Bonadio","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1159\/000503338","article-title":"Bolus-to-Infusion Time in Stroke Patients Treated with Alteplase on the CT Table: A Clinical Concern","volume":"48","author":"Mohedano","year":"2019","journal-title":"Cerebrovasc. Dis."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000489568","article-title":"Target door-to-needle time for tissue plasminogen activator treatment with magnetic resonance imaging screening can be reduced to 45 min","volume":"45","author":"Sablot","year":"2018","journal-title":"Cerebrovasc. Dis."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.04.015","article-title":"Efficacy of New Measures Saving Time in Acute Stroke Management: A Quantified Analysis","volume":"26","year":"2017","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"e00654","DOI":"10.1002\/brb3.654","article-title":"Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden","volume":"7","author":"Eriksson","year":"2017","journal-title":"Brain Behav"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1186\/s13049-016-0251-2","article-title":"Effect of prehospital notification on acute stroke care: A multicenter study","volume":"24","author":"Hsieh","year":"2016","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/MEJ.0000000000000475","article-title":"The positive predictive value of an ambulance prealert for stroke and transient ischaemic attack","volume":"25","author":"Brown","year":"2018","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1089\/tmj.2017.0252","article-title":"Frequent Hub-Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network","volume":"24","author":"Moreno","year":"2018","journal-title":"Telemed. e-Health"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1017\/cjn.2016.416","article-title":"Short- and Long-Term Reduction of Door-to-Needle Time in Thrombolysis for Acute Stroke","volume":"44","author":"Chen","year":"2017","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1161\/STROKEAHA.116.014258","article-title":"Stroke Thrombolysis in a Centralized and a Decentralized System (Helsinki and Telemedical Project for Integrative Stroke Care Network)","volume":"47","author":"Hubert","year":"2016","journal-title":"Stroke"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"3007","DOI":"10.1007\/s12035-016-9750-4","article-title":"Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors","volume":"54","author":"Zhou","year":"2017","journal-title":"Mol. Neurobiol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"506","DOI":"10.20344\/amp.18202","article-title":"Endovascular Treatment in Acute Ischemic Stroke: \u201cUrgency in Reducing Asymmetries\u201d","volume":"35","author":"Nzwalo","year":"2022","journal-title":"Acta Med. Port."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.1097\/JCN.0000000000000313","article-title":"Factors Associated with the Hospital Arrival Time in Patients with Ischemic Stroke in Korea","volume":"31","author":"Sim","year":"2016","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.09.036","article-title":"Response to Symptoms and Prehospital Delay in Stroke Patients. Is It Time to Reconsider Stroke Awareness Campaigns?","volume":"27","year":"2018","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"e002808","DOI":"10.1161\/JAHA.115.002808","article-title":"Prehospital Phase of the Stroke Chain of Survival: A Prospective Observational Study","volume":"5","author":"Puolakka","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.ijcard.2016.03.232","article-title":"Reducing time delays in the management of ischemic stroke patients in Northern Italy","volume":"215","author":"Vidale","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1136\/neurintsurg-2015-011806","article-title":"CODE FAST: A quality improvement initiative to reduce door-to-needle times","volume":"8","author":"Busby","year":"2016","journal-title":"J. Neurointerv. Surg."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1161\/CIRCULATIONAHA.115.019983","article-title":"Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial","volume":"133","author":"Menon","year":"2016","journal-title":"Circulation"},{"key":"ref_111","first-page":"80","article-title":"Use of emergency medical transport and impact on time to care in patients with ischaemic stroke","volume":"34","year":"2019","journal-title":"Neurologia"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.03.016","article-title":"mStroke: \u201cMobile Stroke\u201d\u2014Improving Acute Stroke Care with Smartphone Technology","volume":"26","author":"Andrew","year":"2017","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1161\/STROKEAHA.116.015712","article-title":"Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get with the Guidelines-Stroke","volume":"48","author":"Kamal","year":"2017","journal-title":"Stroke"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.ajem.2017.01.007","article-title":"Creation of an intensive care unit and organizational changes in an adult emergency department: Impact on acute stroke management","volume":"35","author":"Puy","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e11205","DOI":"10.1097\/MD.0000000000011205","article-title":"Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke: A meta-analysis","volume":"97","author":"Huang","year":"2018","journal-title":"Medicine"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1159\/000432405","article-title":"Short Door-to-Needle Times in Acute Ischemic Stroke and Prospective Identification of Its Delaying Factors","volume":"5","author":"Scott","year":"2015","journal-title":"Cerebrovasc. Dis. Extra"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.01.039","article-title":"Beating the clock: Time delays to thrombolytic therapy with advanced imaging and impact of optimized workflow","volume":"24","author":"Chakraborty","year":"2015","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1161\/CIRCULATIONAHA.116.025652","article-title":"Public Health Urgency Created by the Success of Mechanical Thrombectomy Studies in Stroke","volume":"135","author":"Hopkins","year":"2017","journal-title":"Circulation"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/16357\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:35:10Z","timestamp":1760146510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/16357"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,6]]},"references-count":118,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192316357"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192316357","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,6]]}}}