Proven methods to improve door-to-needle times for stroke patients

Accounting for about 133,000 deaths per year, stroke ranks fifth among all causes of death in the United States, according to the American Heart Association. This life-threatening condition occurs irrespective of age and can lead to serious long-term disabilities. With May being recognized as National Stroke Awareness month, it serves as a reminder to hospitals and health systems to expand their understanding and spread the knowledge to patients on ways to tackle this illness and the damage that follows.

It won’t come as a surprise to any physician that strokes require time-sensitive treatment. While organizations are putting together ongoing efforts to help patients identify avoidable risk factors to curb stroke from occurring, it is also imperative for patients to be aware of the warning signs that present themselves while experiencing the episode and act instantly to prevent further complications. Recognizing the symptoms early can accelerate treatment, which is the primary goal of Target: Stroke—a national quality improvement initiative launched in 2010 by the American Heart Association and its American Stroke Association division. Many hospitals have been successful in reducing door-to-needle times (DTN) using Target: Stroke care strategies that allow IV tissue plasminogen activator (tPA) to be administered within 60 minutes of hospital arrival, leading to improved patient outcomes.

Keeping this initiative in mind, several organizations, especially those participating in AHA’s “Get With The Guidelines®–Stroke” program, have found various methods to improve their DTN times:

  • Act FAST to Identify Symptoms: Stroke is treatable if caught early. Kennestone Hospital in Marietta, Georgia, implemented CODE FAST, a QI project that involved assembling a multidisciplinary team, training EMS to perform examinations for facial drooping, arm weakness, speech difficulties, and time (FAST), and standardizing the care process to carry out several interventions simultaneously. This initiative successfully led to reduction in median DTN from 62 to 25 minutes.
  • Implement Protocol-Driven Models: A Six Sigma-based QI project called the “pit-crew” model by West Virginia University focused on reducing stroke treatment times via identifying key people in the team, defining responsibilities of each, and underlining “parallel processing” of assigned steps. By doing so, they saw a lower duration for all the steps they examined, namely ED arrival to CT scan time, and overall time from ED arrival to groin puncture time.
  • Adhere to National QI Initiatives: Kaiser Permanente Northern California updated the acute stroke workflow among its 21 stroke centers by introducing the stroke EXPRESS program, which involves a standardized modified Helsinki protocol along with the use of telestroke technology that enables a specialized neurologist to oversee all emergency stroke patients. This venture led to significant reduction in DTN times—from 53.5 to 34.0 minutes—and increased alteplase administrations.

Additionally, a 2019 study details the successes of the CDC’s Paul Coverdell National Acute Stroke Program—an acute stroke quality of care registry that funds state health departments to track and measure acute stroke care and examines the changes in DTN times and factors associated with it. Significant and steady improvements in DTN times less than 60 minutes and less than 45 minutes were observed among the participating hospitals over 10 years, signifying the success of this program.

Controlling risk factors, spotting warning signs, and acting fast can often make a lifesaving difference among this patient population. If you want access to more information focused on stroke care or to our analyst team that answers custom research requests, inquire about joining our community today!

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