Effectiveness of in-hospital nurse-driven services in shortening the delay to thrombolysis in acute ischemic stroke: A systematic review and meta analysis

Abstract Background Multidisciplinary stroke teams, especially those including a dedicated stroke nurse, play a crucial role in optimizing the management and timely administration of intravenous thrombolysis. Studies have explored in-hospital, nurse-driven service models where nurses assume full responsibility or provide continuous accompaniment throughout the care process, which can reduce the time to intravenous thrombolysis for patients with acute ischemic stroke(AIS). Objective This review systematically evaluates the efficacy of the in-hospital, nurse-driven service model in shortening the time to intravenous thrombolysis. It also aims to define the roles and responsibilities of nurses within the stroke emergency green channel process. Methods A search of six electronic databases was conducted to identify eligible trials published up to september 30, 2025. Quasi-experimental studies comparing nurse-driven models for reducing intravenous thrombolysis time in AIS patients were included. The primary outcome was door-to-needle time(DNT). Secondary outcomes included Door-to-physician time, Door-to-imaging time, Registration to Check Time, and image completion-to-needle time. Data extraction and quality assessment were performed. Results are presented as risk ratios or mean differences, analyzed using fixed- or random-effects models as appropriate. Heterogeneity was assessed using the I² statistic. Results A total of 27 trials and 5725 participants were included. The meta-analysis results indicate that nurse-driven service models significantly reduces the following time intervals: Door-to-needle time [MD=-16.72, 95%CI(-21.42, -12.02), P<0.001]; onset to treatment time [MD=-9.80, 95%CI(-15.04, -4.56), P=0.37]; Door-to-physician time[MD=-1.68, 95%CI(-2.36, -1.00), P<0.001]; Door-to-imaging time[MD=-8.96, 95%CI(-13.15, -4.77), P<0.001]; Registration to Check Time[MD=-1.76, 95%CI(-3.23, -0.30), P<0.001]; and image completion-to-needle time[MD=-13.73, 95%CI(-21.12, -6.34), P<0.001]. Conclusion Adopting the nurse-driven intravenous thrombolysis care model can significantly reduce the total time from hospital arrival to thrombolysis for AIS patients. Nurses' involvement in every stage of stroke treatment can effectively address the lack of unified coordination and seamles, when personnel from different disciplines are only responsible for one or a few specific tasks. Additionally, nurses' participation helps resolve treatment delays caused by patients' cumbersome medical procedures.