Discrepancies between predicted and actual time delays in the in-Hospital Management of Acute Cerebral Infarction: A...

Effective time management is critical to achieving successful recanalization in acute cerebral infarction. In-hospital delays, however, remain a major challenge. This study aimed to quantify discrepancies between healthcare providers' predicted and actual times spent on critical steps in acute cerebral infarction management, and to identify specific, modifiable contributors to in-hospital delay that can inform targeted process optimization.

A single-center prospective observational study was conducted at a national stroke center. Thirty staff involved in acute ischemic stroke care including emergency physicians, neurologists, neurointerventionalists, neurointerventional suite nurses and medical imaging/clinical laboratory physicians were randomly selected. Participants were asked to estimate the time required for critical steps in the patient management process. These predictions were compared against the actual times recorded during clinical practice.

Initial physician contact to completion of imaging was reduced by 1.83 min (95% CI: -2.97 to -0.96), representing a 26.1% reduction in time. Neurologists received consultation requests from emergency physicians to initial patient contact was shortened by-0.16 min (95% CI: -0.82 to 0.49), representing a 4.7% reduction. Physicians' actual time management took less time than predicted, while other physicians' actual time management took longer than predicted, resulting in delays. The difference between predicted and actual time from emergency physician's initial patient contact to completion of imaging examination (t(95% CI:0.77 to 2.89) = 3.53, p = 0.001); Difference between predicted and actual time from patient family consent for neuroendovascular procedure to patient transport to suite (t(95% CI:-3.51 to -0.16) = -2.24, p = 0.03); Difference between predicted and actual time from family consent for neuroendovascular procedure to patient transport to suite (t(95% CI:-4.31 to -2.02) = -5.6, p < 0.05); Difference between predicted and actual time from receiving neuroendovascular procedure orders to initial patient contact by suite nurses (t(95% CI:-3.42 to -1.85) = -6.84, p < 0.05); Difference between predicted and actual time from receiving laboratory test orders to issuing patient results (t(95% CI:-5.92 to -3.55) = -8.14, p = 0.001).

Clinical healthcare providers consistently underestimate the time required for critical steps in acute cerebral infarction management and this prediction bias is a major cause of in-hospital delays. To optimize patient outcomes, stroke centers must establish more scientific and standardized time management protocols, alongside effective cross-departmental coordination mechanisms, to improve the efficiency of the entire in-hospital treatment pathway.