Impact of a code stroke protocol on the door-to-needle time for IV thrombolysis: a feasibility study

Stroke is a development of an acute focal neurological deficit with an ischemic or hemorrhagic origin. Thrombolysis within 4.5 h of ischemic stroke onset improves outcome. Guidelines recommend administration of intravenous recombinant tissue plasminogen activator within 60 min upon arrival at the hospital, meaning the door-to-needle time (DNT) should be less than 60 min. In this study, a stroke protocol was introduced at the emergency department of the Ghent University Hospital with a primary goal to shorten the DNT.

This study was an uncontrolled before-after cohort study. A 'Code Stroke' protocol (CSP) was implemented and the results from the pre-code stroke protocol period (Pre-CSP period, from 15 August 2016 until 5 March 2017) were compared with the results from the post-code stroke protocol period (Post-CSP period, from 6 March 2017 until 16 July 2017).

The median DNT decreased significantly from 57 min in the Pre-CSP period to 33 min in the Post-CSP period (p < 0.001). The door-to-triage time (DTT), triage-to-emergency physician time (TET), emergency physician-to-CT time (ECT) and CT-to needle time (CNT) decreased significantly Post-CSP compared to Pre-CSP. When adjusting the results for other variables that might have an influence on these time intervals, the TET, ECT and CNT also decreased significantly. There was a statistically significant effect of the implementation of the CSP on the number of patients treated with a DNT within 20, 30, 45 and 60 min (p = 0.008).

A significant decrease in DNT can be achieved with the implementation of this stroke protocol.