An in-hospital stroke system to optimize emergency management of acute ischemic stroke by reducing door-to-needle time

Abstract

BackgroundDoor-to-needle time (DNT) is a critical consideration in emergency management of acute ischemic stroke (AIS). Deficiencies in the widely applied standard hospital workflow process, based on international guidelines, impede rapid treatment of AIS patients. We developed an in-hospital stroke system to reduce DNT and optimize hospitals' emergency procedures. ObjectivesTo investigate the effect of the in-hospital stroke system on the hospital workflow for AIS patients. MethodsWe performed a retrospective study on AIS patients between June 2017 and December 2021. AIS cases were assigned to a pre-intervention group (before the in-hospital stroke system was established) and a post-intervention group (after the system's establishment). We compared the two groups' demographic features, clinical characteristics, treatments and outcomes, and time metrics data. ResultsWe analyzed 1031 cases, comprising 474 and 557 cases in the pre-intervention and post-intervention groups, respectively. Baseline data were similar for both groups. Significantly more patients in the post-intervention group (41.11%) were treated with intravenous thrombolysis (IVT) or endovascular therapy (ET) compared with those in the pre-intervention group (8.65%) (p < 0.001). DNT was markedly improved (decreasing from 118 (80.5–137) min to 26 (21–38) min among patients in the post-intervention group treated with IVT or bridging ET. Consequently, a much higher proportion of these patients (92.64%) received IVT within 60 min compared with those in the pre-intervention group (17.39%) (p < 0.001). Consequently, their hospital stays were shorter (8 [6–11] days vs. 10 [8–12] days for the pre-intervention group; p < 0.001), and they showed improved National Institutes of Health Stroke Scale (NIHSS) scores at discharge (−2 [−5–0] vs. −1 [−2–0], p < 0.001). ConclusionDNT was significantly reduced following implementation of the in-hospital stroke system, which contributed to improved patient outcomes measured by the length of hospital stay and NIHSS scores.