Time Matters: Reducing Door to Needle Times in a Major Stroke Centre

Abstract Background Target times for intravenous thrombolysis (IVT) is under 4.5 hours as established in the ESO guidelines, however clinical outcomes improve with faster door to needle times (DTN). The Irish National Audit of Stroke (INAS) shows that most patients present to hospital around 3 hours after symptoms onset. INAS target for DTN time is under 60 minutes, and our hospital’s target is under 30 minutes, and CT scan in under 10 minutes. In 2023 we were not meeting our established targets so we performed a quality improvement project to improve our DTN times. Methods With an average of 1000-1200 FAST calls a year, around 10% of strokes received IVT. The average DTN from 2019-2022 was 56 minutes, and average door to CT time of 22.5 minutes. Focusing on system changes, with multidisciplinary involvement, we reorganized the FAST call pathway: radiographers are pre-alerted, patients go directly to ED CT, development of FAST communication proforma, IVT administered in CT room. Results In 2024 there were 1128 FAST calls, with 342 ischaemic strokes. Our average time to CT brain was 12 minutes, down 8 minutes from 2023. Our average DTN time was 37 minutes, down 14 minutes from 2023. We were able to achieve a door to decision time of less than 25 min in 2024, down 8 minutes from 2023. Inpatient FAST calls saw a reduction in time to IVT by 25 minutes. Overall we reduced our door to CT times by 50%, DTN times by 34% and Inpatient FAST times by 25%. Conclusion This quality improvement project demonstrates the efficacy of small changes. By streamlining our FAST pathway for ED and inpatients, we drastically reduced our time to thrombolysis. We are still above target and have planned further improvement projects focused on NCHD teaching and ongoing assessment for areas to improve our FAST calls.