title: Achieving a door-to-needle time of 25 minutes in thrombolysis for acute ischemic stroke: a quality improvement project.
abstract: BACKGROUND
  Providing intravenous thrombolysis with short door-to-needle time is the result of a complex process that requires specific work standards. To expedite care for acute ischemic stroke patients, close collaboration between all participating health care professionals is required. The aim of this project was to reduce in-hospital treatment delay for acute ischemic stroke patients through the introduction of a standard operating procedure and by creating higher and sustained awareness of the importance of intravenous thrombolysis.
  
  
  METHODS
  This study was set up as a before-versus-after study, divided into a preintervention period, an immediate postintervention period, and a late postintervention period. During the study, a standard operating procedure was implemented that defined the targeted standard of care to be provided to all acute stroke patients. Involved health care professionals received regular feedback to create greater awareness of the importance of this time-driven protocol.
  
  
  RESULTS
  The median door-to-needle time decreased significantly, from 60 minutes in the preintervention period to 30 minutes in the immediate postintervention period (P < .001), and compared with the immediate postintervention period it decreased significantly further, to 25 minutes, in the late postintervention period (P < .001). The proportion of patients with a door-to-needle time <30 minutes and <20 minutes increased significantly across the 3 study periods (P < .001).
  
  
  CONCLUSIONS
  The door-to-needle time for acute ischemic stroke patients can be reduced through the introduction of a standard operating procedure and by creating higher and sustained awareness of the importance of intravenous thrombolysis among health care professionals involved.
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands. Electronic address: svschaik@gmail.com.
authors.forename: Sander M
authors.initials: SM
authors.lastname: Van Schaik
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Van der Veen
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Renske M
authors.initials: RM
authors.lastname: Van den Berg-Vos
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Weinstein
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Wendy M J
authors.initials: WMJ
authors.lastname: Bosboom
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D019091:Critical Pathways / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000592:standards*; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Stroke; emergency service; hospital; quality of health care; thrombolytic therapy; time factors