title: The Stroke Chronometer-A New Strategy to Reduce Door-to-Needle Time.
abstract: In acute stroke patients' treatment, time is of utmost importance. Significant efforts must be made to reduce door-to-needle time (DNT), taking into account its effect on treatment efficacy and patients' prognosis. The objective of this study is to assess the effect of implementing a countdown timer in the acute stroke emergency room, on door-to-computed tomography time (DCTT) and DNT.
  
  
  
  Implementation of protocol that postulates the activation of a countdown timer every time an acute stroke patient is admitted. DCTT and DNT in patients submitted to thrombolysis were compared before and after the implementation of the chronometer. Multivariate analysis of DNT and DCTT was conducted adjusted to age, sex, National Institutes of Health Stroke Scale at admission, time from stroke onset to admission, and anterior circulation.
  
  
  
  Of the 76 patients treated with thrombolysis in 2015 in our hospital, 71 had stroke code activation by the emergency medical services or at hospital admission. Protocol was initiated on July 1, with 41 patients (58%) included in the second semester. The Stroke Chronometer implementation resulted in a reduction of the mean DCTT from 27.1 to 18.4 minutes (P = .004; 95% CI 2.56-12.45) and of the mean DNT from 52.7 to 39.2 minutes (P = .016; 95% CI 2.49-23.18), respectively, first and second semesters.
  
  
  
  The Stroke Chronometer strategy has revealed to be an effective method to reduce DCTT and DNT.
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal. Electronic address: joao.pedro.seabra.marto@gmail.com.
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Marto
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Borbinha
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal; CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Calado
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal; CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Viana-Baptista
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D061665:Time-to-Treatment
chemical_list: D005343:Fibrinolytic Agents
keywords: Door-to-computed tomography time; door-to-needle time; stroke chronometer; stroke treatment; thrombolysis