Establishing and monitoring target time goals for ED door-to-treatment IV fibrinolysis time can be beneficial to monitor and enhance system performance. I B-NR New recommendation. In AHA GWTG-Stroke hospitals, median DTN time for IV alteplase administration decreased from 77 minutes (interquartile range, 60 98 minutes) during the 2003 to 2009 preintervention period to 67 minutes (interquartile range, 51 87 minutes) during the 2010 to 2013 postintervention period (P<0.001). The percentage of alteplase-treated patients having DTN times of 60 minutes increased from 26.5% (95% CI, 26.0 27.1) to 41.3% (95% CI, 40.8 41.7; P<0.001). Comparing the quarter immediately before the intervention (quarter 4 of 2009) and the final postintervention quarter (quarter 3 of 2013) showed that DTN times of 60 minutes increased from 29.6% (95% CI, 27.8 31.5) to In a subsequent study evaluating a cohort of hospitals from 2014 to 2015, 59.3% of patients received IV alteplase within a DTN time of 60 minutes.54 See Table IX in online Data Supplement 1. 1.6. Telemedicine COR LOE New, Revised, or Unchanged For sites without in-house imaging interpretation expertise, teleradiology systems approved by the US Food and Drug Administration are recommended for timely review of brain imaging in patients with suspected acute stroke. I A Recommendation revised from 2013 AIS Guidelines. When implemented within a telestroke network, teleradiology systems approved by the US Food and Drug Administration are effective in supporting rapid imaging interpretation in time for IV alteplase administration decision making. I A Recommendation reworded for clarity from 2013 AIS Guidelines. COR unchanged. LOE revised. See Table XCV in online Data Supplement 1 for original wording. 