Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience

Abstract

Background and Aims: Thrombolysis has been shown to improve stroke outcomes by reducing disability, particularly when administered early. Lowering the door-to-needle time (DNT) for administering intravenous thrombol¬ysis (IVT) is an important objective for improving the quality of acute stroke care. This study aims to compare DNT before and after implementing the code stroke pathway protocol. Methods: The study evaluated the impact of a quality improvement project, Code Stroke, on acute ischemic stroke patients at King Fahd General Hospital in Jeddah, Saudi Arabia, September 2019 to April 2020, using a retrospective record-based analysis, with data extracted using a standardized format and cat¬egorized into pre and post code groups. Results: 81 stroke patients were reviewed, with 47 in the pre-code group and 34 in the post-code group. The re¬ported tPA DNT time was less than 60 minutes in only 8.5% of patients before the implementation of stroke code activation, compared to 55.9% after implementation (p=.001). Incidence of symptomatic hemorrhagic transformation was 8.6%. Post-code group had a lower median length of hospital stay (8 days) compared to the pre-code (13 days), with a marginal trend towards statistical significance, and half of the post-code group patients had a modified Rankin Scale of 0-2 compared to one third of the pre-code group at three months of discharge. Conclusions: The Code Stroke project resulted in a significant reduction in DNT, improved functional outcomes, and a reduction in hospital length of stay, but the incidence of symptomatic intracranial hemorrhage and in-hospital mortality rates were slightly higher than expected, requiring continued improvement efforts.