Time is Brain: A Nurse-Informed Multicenter Analysis of Hospital-Based Mechanical Thrombectomy Pathway Efficiency (HASTE)

Background Swift response and successful reperfusion are major determinants of outcome in acute ischemic stroke due to large vessel occlusion. Quality initiatives in stroke care have shown that organized, protocol-driven practice can shorten treatment times and improve safety-sensitive clinical outcomes, yet thrombectomy workflow variation persists across health systems, and few studies have translated workflow findings into operational recommendations. Methods This retrospective, multicenter study evaluated mechanical thrombectomy workflow performance across 16 facilities in a large United States health system from August 2020 through December 2021. Elastic net regularization was applied to patient-level characteristics to generate residual durations for door-to-imaging, door-to-puncture, imaging-to-puncture, puncture-to-reperfusion, and door-to-reperfusion times. Residual durations were evaluated using iterative multivariable linear regression to identify facility-level workflow indicators associated with shorter times while adjusting for confounders. Statistically significant indicators were reviewed by a multidisciplinary HASTE (Hospital-bAsed Protocol to Standardize ThrombEctomy) Working Group and translated into evidence-informed preferred practices. Results Workflow indicators associated with faster reperfusion were identified and organized into 3 domains: people, process, and technology. Prominent findings included clearly defined team roles and responsibility, standardized workflow protocols and preparation, direct communication, and remote neuro-imaging review. Direct-admit patients had a median door-to-reperfusion time of 127 minutes (interquartile range [IQR], 96-166), whereas interfacility-transfer patients had a median door-to-reperfusion time of 73 minutes (IQR, 53-116). Patients treated at facilities reporting a standardized mechanical thrombectomy protocol demonstrated shorter median door-to-reperfusion times for both direct-admit patients (111 vs 148 minutes) and interfacility-transfer patients (66 vs 87 minutes). Conclusion Across 16 facilities, faster reperfusion was associated with workflow characteristics involving role clarity, direct communication, standardized preparation, and technology-enabled imaging review. Multidisciplinary interpretation of these findings informed real-world translation of care pathway tactics to improve thrombectomy pathway reliability and efficiency.