Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience

Area of Science:

• Neurology
• Interventional Cardiology
• Healthcare Quality Improvement

Background:

• The door-to-groin puncture (DTP) time is a critical metric in acute ischemic stroke care.
• Reducing DTP time is essential for improving patient outcomes and minimizing neurological damage.
• Existing literature and quality improvement projects highlight the need for effective DTP time reduction strategies.

Purpose of the Study:

• To systematically review methods for reducing DTP time in stroke patients.
• To present the results of a quality improvement project focused on DTP time reduction.
• To enhance understanding of strategies that improve patient outcomes through faster intervention.

Main Methods:

• A systematic literature search was performed across major databases (Ovid MEDLINE, EMBASE, Scopus, Web of Science).
• Eligible studies evaluating DTP time reduction strategies were assessed for quality and meta-analyzed.
• A quality improvement project at Mayo Clinic Arizona implemented a single-call activation system.

Main Results:

• Fourteen studies involving 2277 patients with large-vessel occlusion strokes were analyzed.
• A significant pooled reduction in DTP time was observed (standardized mean difference 1.37; P<.001).
• The Mayo Clinic project reduced DTP time from 125.1 to 82.5 minutes post-implementation.

Conclusions:

• Computed tomography flow modifications showed the most consistent DTP time reduction.
• Systematic protocols for DTP time reduction yield beneficial effects for stroke patients.
• Further research is needed on DTP time reduction strategies, particularly with the rise of mechanical thrombectomy.