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Updated: Jul 30, 2026
09:52
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
17.1K
Door-In-Door-Out Times and Functional Outcomes after Stroke in a Large Canadian Hub-and-Spoke Network
Summary
Door-in-door-out metrics (DIDO) for acute ischemic stroke patients undergoing endovascular thrombectomy (EVT) were not linked to 90-day functional outcomes or death. Improving workflow outside daytime hours may reduce DIDO at primary stroke centers.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Door-in-door-out (DIDO) metrics for acute ischemic stroke patients undergoing endovascular thrombectomy (EVT) and their impact on outcomes are not well understood.
- Investigating DIDO determinants and their association with functional outcomes is crucial for stroke care optimization.
Purpose of the Study:
- To examine the association between DIDO and 90-day functional outcomes in acute ischemic stroke patients transferred for EVT.
- To identify patient clinical and workflow characteristics associated with DIDO.
Main Methods:
- Retrospective, province-wide cohort study of 790 acute ischemic stroke patients transferred for EVT in Québec, Canada (2017-2020).
- DIDO calculated as time spent in the primary stroke center (PSC) emergency department.
- Logistic mixed models used to assess associations between DIDO, functional outcomes (modified Rankin score 0-2, death at 90 days), and patient characteristics.
Main Results:
- Median DIDO was 102 minutes; no significant association found between DIDO and 90-day favorable functional outcome or death.
- Arrival at the PSC outside daytime hours was significantly associated with longer DIDO (≥ 60 minutes).
Conclusions:
- Long DIDO times in Québec do not appear to impact 90-day functional outcomes or mortality for EVT transfer patients.
- Further research needed to identify and improve modifiable determinants of DIDO, particularly concerning off-hours workflow.
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