Introduction
Though studies have shown that recombinant tissue plasminogen activator (rtPA) significantly improves health outcome for patients with acute ischemic stroke, its effects are however highly time-dependent. In 2015, the median door to needle time (DTN) for rtPA administration at Khoo Teck Puat Hospital was 73 minutes.  Our aim was to improve our median DTN time to less than 60 minutes.

Methods
Prior to nurse facilitators, rtPA was administered by ED doctors and the DTN time was often prolonged as one of the factors identified was unfamiliarity with the stroke activation process. Neuro-trained nurses were introduced to facilitate the stroke activation process (Figure 1). Their role was to hasten the process of procuring neuroimaging, performance of National Institute of Health Stroke Scale (NIHSS), neurological assessments, and facilitating telemedicine consult and patient education regarding rTPA for consent taking. 

Results 
Of the 58 activations involved from July 2016 to July 2017, we achieved a median DTN time of 47 minutes for 13 rtPA cases facilitated by nurses, compared to a median DTN time of 67.5 minutes for cases not facilitated by nurses during the same time period. 

Conclusion
The introduction of APN Facilitated Stroke Activation has significantly reduced the median DTN time to less than 60 minutes. This also emphasizes the need to train more nurses for such roles.

NURSE-FACILITATED RTPA ADMINISTRATION IN REDUCING DOOR TO NEEDLE TIME