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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
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Nursing-Led Quality Improvement Project Achieves 30-Minute Door-to-Needle Time.
Journal of Emergency Nursing
|November 21, 2025
Summary
Telestroke care significantly reduced door-to-needle times for stroke patients, achieving goals through workflow optimization. This quality improvement initiative improved treatment rates and timely care delivery.
Area of Science:
- Neurology
- Emergency Medicine
- Healthcare Quality Improvement
Background:
- Delays in intravenous thrombolytic administration persist in emergency departments despite existing telestroke services.
- Optimizing emergency stroke care pathways is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of a quality improvement project on reducing door-to-needle time in telestroke care.
- To assess the effectiveness of workflow optimization, enhanced communication, and real-time feedback in streamlining stroke treatment.
Main Methods:
- Implementation of a quality improvement project focused on stroke care workflow optimization.
- Inclusion of education, improved communication strategies, and real-time feedback mechanisms.
- Retrospective analysis of door-to-needle times and intravenous thrombolytic rates before and after project implementation.
Main Results:
- A significant reduction in door-to-needle time by 18.05 minutes was observed (P = .001).
- Post-implementation, door-to-needle time goals (30, 45, 60 minutes) were consistently met (adjusted P < .005).
- Intravenous thrombolytic rates increased significantly after implementation (adjusted odds ratio, 1.91; P = .001).
Conclusions:
- A nurse-led workflow at a telestroke-enabled primary stroke center consistently achieved door-to-needle times under 30 minutes.
- Early stroke alerts and rapid computed tomography scans are key components of the successful workflow.
- The quality improvement project demonstrated a substantial enhancement in the efficiency and effectiveness of acute stroke care.
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