Decision for tPA Administration, Not Response Time, Contributes Most to Variation in Thrombolysis Times Onboard Mobile Stroke Unit

BackgroundHospitals have improved stroke thrombolysis times through rigorous assessment of care delays. However, this same rigor has not yet been applied to the novel setting of mobile stroke units (MSUs).MethodsWe reviewed all cases of intravenous tPA (tissue‐type plasminogen activator) administration onboard our MSU in Rochester, NY, since its first complete year of operation in 2019. The dispatch timeline was divided into 6 intervals: (1) response time, (2) onboarding time, (3) head computed tomography collection, (4) head computed tomography reading, (5) decision time, and (6) intravenous tPA administration.ResultsThe mean±SD total time between MSU dispatch and tPA was 42±8.4 minutes (range, 26–60 minutes; N=53). The largest mean duration was in (1), between dispatch and arrival (12.0±4.7 minutes). However, the intercase variation was greatest in (5), between head computed tomography reading and treatment decision (6.3±6.2 minutes). After ranking cases by total time, the mean decision times of first and fourth quartile cases varied the most, by a factor of 2.45, whereas the mean times for the other intervals varied by