Effect of a mobile-based intervention (Code Sama) on door-to-needle time in acute ischemic stroke patients: a...

Door-to-needle (DTN) time is a critical performance metric in acute ischemic stroke management, as delays are directly associated with poorer clinical outcomes. This study evaluated the effect of a mobile-based software intervention (Code Sama) on reducing DTN time in the emergency department (ED).

This quasi-experimental study employed a non-equivalent control group, pretest-posttest design, conducted at a comprehensive stroke center in Tabriz, Iran. Sixty emergency department nurses participated in implementing a mobile-based clinical decision support application. Patient data were collected through direct observation using a validated timing checklist. The control group comprised 60 acute ischemic stroke patients managed with routine care over an 8-week period. The intervention group included 60 patients treated after nurses received training on and began using the "Code Sama" application. The primary outcome, door-to-needle time, was measured by trained observers present around the clock who recorded timestamps at key care milestones. Data were analyzed using independent t-tests following confirmation of normality assumptions.

Patient groups were homogenous regarding baseline demographic and clinical characteristics, including age, sex, and NIHSS score (p > 0.05). No significant difference was found in mean DTN time between the control group's baseline (48.60 ± 2.52 min) and the intervention group's pretest (48.23 ± 2.40 min). Following the intervention, the mean DTN time in the intervention group decreased significantly to 42.96 ± 1.45 min. This reduction was statistically significant compared to its own pretest (t(48) = 10.25, p < 0.001) and to the control group's post-period (t(47) = 10.58, p < 0.001), with a very large effect size (Cohen's d > 2.5).

Implementation of the "Code Sama" mobile-based intervention was associated with a significant reduction in door-to-needle time for acute ischemic stroke patients. These findings suggest this tool may serve as a feasible strategy to support emergency workflow optimization, though confirmation through randomized controlled trials is warranted.

This study was registered with the Iranian Registry of Clinical Trials (IRCT). We acknowledge that prospective registration would have been preferable the registration occurred because the study was initially conceptualized as a quality improvement initiative rather than a clinical trial. Upon recognition that the findings warranted publication, registration was completed to ensure transparency.