Door to Imaging Time: Better but Still Not Good Enough

Abstract of primary author Background Acute stroke is a medical emergency associated with significant morbidity and mortality. Timely neuroimaging is essential, with an estimated loss of 2 million neurons per minute of ischaemia. The 2023 National Clinical Guidelines for Stroke recommend brain imaging be performed as soon as possible and within one hour of hospital arrival for all patients with suspected stroke. Methods This audit aimed to evaluate adherence to best practice targets for door-to-imaging (DTI) time in our model three center, building on a 2021 audit where 45% of patients with confirmed stroke had DTI times greater than four hours. Since then, outsourcing of CT vetting and reporting was introduced to improve imaging access. We reviewed all patients presenting to this model three center between January and June 2024 with confirmed ischaemic or haemorrhagic stroke on neuroimaging. Patients were stratified by DTI time: within one hour, between one and four hours, and greater than four hours. Cases exceeding four hours were further analyzed to determine the reasons for delay. Results Between January 1st and June 30th, 2024, 150 patients were diagnosed with stroke on neuroimaging. Of these, 91 patients (60.7%) were imaged within one hour, 36 (24%) within one to four hours, and 23 (15.3%) after more than four hours. In the delayed imaging group, four were not initially recognized as stroke, eight were diagnosed clinically as TIA and not prioritized for urgent imaging, one experienced a delay in performing the scan, and ten had delays in scan ordering. Conclusion Access to timely imaging has improved significantly in this center, with a notable reduction in prolonged DTI times. Continued emphasis on early stroke recognition and prioritization of imaging, particularly in suspected TIA cases, is essential to optimize patient outcomes.