Abstract TP037: Reducing Door-to-Needle Times in the Emergency Department Through Optimized Code Stroke Workflow and Early CT Thrombolytic Administration

Background: In acute stroke management, reduced time to treatment is strongly correlated with improved patient outcomes. Community hospitals tend to experience lower case volumes, which can hinder efficient workflows. This can influence time-sensitive treatment for acute ischemic stroke patients. The American Heart Association’s (AHA) Target Phase II study identified best practices for reducing door-to-needle (DTN) times for acute ischemic strokes. One of the most impactful strategies acknowledged was administering thrombolytic therapy directly in the computed tomography (CT) scanner. This approach prevents delays in treatment associated with waiting until the patient is transferred back to the Emergency Department (ED) and has been shown to decrease DTN times significantly. Mastering this technique also requires the AHA best practice of a team-based approach. The purpose of this study was to determine if optimized Code Stroke workflows in the ED would decrease DTN times and improve patient outcomes. Method: In 2025, a revised Code Stroke Protocol was created and implemented across two Primary Stroke Center (PSC) Emergency Departments. Retrospective internal data was collected and analyzed to evaluate the impact of ED workflow, including the administration of thrombolytic therapy in the CT scanner, on timely stroke treatment, with a focus on DTN times for thrombolytic therapy. We compared the DTN data from 2023-2024 to that of 2025. Findings: A total of 53 cases were analyzed across two PSC EDs before and after implementing the new Code Stroke workflow, including administering thrombolytic therapy in the CT scanner. While a significant decrease in DTN times was observed at only one of the two hospitals ( p < 0.05), median DTN times substantially improved at both sites. Both hospitals also achieved DTN times of ≤60 minutes for greater than 50% of cases in 2025. This benchmark was not reached in the 2023-2024 data, indicating enhanced timeliness of overall acute ischemic stroke treatment. The lack of statistical significance at the first hospital may be due to lower case volume. Conclusion: Our data demonstrates that optimizing the workflow for the ED Code Stroke process, including administration of thrombolytic therapy in CT, is associated with reduced thrombolytic DTN times. While implementing this protocol throughout PSCs could be effective in improving stroke DTN metrics, further research is warranted to explore hospitals with larger case volumes.