Background: Patient outcomes improve when the initial management of acute ischemic stroke (AIS) focuses on decreasing process times in recognition, imaging, and treatment. American Stroke Association guidelines recommend Door to Needle (DTN) times of <60 minutes for at least 85% of AIS patients, with further goals of DTN times of <45 minutes for 75% of patients, and <30 minutes for 50% of patients. Our community hospital system consists of a hub-n-spoke model of five community Primary Stroke Centers (PSC), one Acute Stroke Ready Center, and a hub regional Comprehensive Stroke Center (CSC). In the spoke centers, we moved all initial care processes to the Radiology suite, site by site over a period from 2020 to 2024. We present data showing improved DTN times across the system as these changes were implemented. Methods: Multidisciplinary Stroke Teams at each site examined delays in DTN times, identifying treatment barriers to develop the Transition of Care to Computed Tomography (CT) process. This retrospective study analyzes prospectively collected data from our system's six spoke hospitals during and after implementation of the new process. The care process consists of initial Physician evaluation at Emergency Department (ED) triage for patients with stroke-like symptoms. Stroke Alert is initiated for patients concerning for acute stroke, who are within the therapeutic window. The patient is then taken directly to the CT scanner in the Radiology suite, with a Tele-Stroke robot and Pharmacy cabinet stocked with thrombolytics and anti-hypertensives. After initial non-contrast CT head imaging, the Stroke Neurologist evaluates the patient via Tele-Stroke and makes recommendations for thrombolytics. Thrombolytics are administered in the Radiology suite before transferring the patient back to the ED for continued care. Results: Moving the initial stroke care process to CT resulted in improvement in average DTN times across the system, from 41 minutes in 2023 (one site with process) to 36.8 minutes in 2024 (four sites with process, two sites initiating), to 35.5 minutes for the first half of 2025 (all sites fully transitioned). Tele-Neuro volumes remained consistent with 753 patients in 2023, 754 in 2024, and 462 for the first half of 2025, with thrombolytic administration rates of 5.4% to 9.95% during this time. Conclusions: Transition of initial stroke care completely to CT resulted in system-wide improvements in DTN metrics in our community hospital system.
Johnson et al. (Thu,) studied this question.