Stroke Code Activation Time Audit

Audit template for reviewing stroke code response times, including door-to-CT, door-to-needle, and door-to-puncture performance.

Case Identification and Stroke Code Activation

• Stroke code activation time documented
  Activation time is recorded in the chart or stroke log with a clear timestamp.
• Last known well time documented
  Last known well or symptom onset time is documented and clinically plausible.
• Stroke code activation appropriateness
  Activation criteria were met based on presenting symptoms and triage findings.
• Initial NIHSS documented
  Baseline neurologic severity score is documented when applicable per local stroke workflow.

Imaging Workflow

• Door-to-CT time (minutes)
  Time from ED arrival to CT start or CT completion, per local metric definition.
• CT completed without avoidable delay
  No preventable delay occurred in transport, scanner availability, or patient preparation.
• CT interpretation time documented
  Time to radiology or stroke team interpretation is documented.
• Imaging workflow delay category
  Primary reason for any imaging delay.

Thrombolytic Treatment Timing

• Door-to-needle time (minutes)
  Time from ED arrival to thrombolytic administration.
• Eligibility decision documented before treatment
  Contraindications, inclusion criteria, and treatment decision are documented before administration.
• Medication preparation and administration delay reason
  Primary cause of any delay between decision and administration.
• Thrombolysis administered per protocol
  Dose, route, and monitoring steps followed local stroke protocol.

Endovascular Therapy Timing

• Door-to-puncture time (minutes)
  Time from ED arrival to arterial puncture for endovascular therapy.
• Transfer or interventional team activation documented
  Activation of the interventional team or transfer pathway is documented with timestamps.
• Delay source for puncture workflow
  Primary reason for any delay to puncture.
• Pre-puncture checklist completed
  Required pre-procedure checklist items were completed before puncture.

Documentation and Quality Review

• All key timestamps documented
  Arrival, activation, CT, treatment, and puncture timestamps are complete and internally consistent.
• Variance or delay documented with cause
  Any delay beyond target is explained with a specific cause and contributing factors.
• Case routed for quality review if target missed
  Cases exceeding local targets are escalated to stroke quality review or committee follow-up.