Impact of hospital process reengineering on door-to-needle time for intravenous thrombolysis in acute ischemic stroke (PROMISE-CHINA): a multicenter prospective pre-post quasi-experimental study

Background Intravenous thrombolytic therapy significantly improves the prognosis of patients with acute ischemic stroke in a time-dependent manner. This study aims to evaluate the effectiveness of hospital process reengineering in reducing delays to intravenous thrombolysis in patients with acute ischemic stroke. Methods This multicenter, prospective, nonrandomized quasi-experimental (pre-post) study included patients with acute ischemic stroke presenting within 3.5 h of symptom onset. Hospital process reengineering involved key measures such as pre-notification by emergency medical services, simultaneous activation of a multidisciplinary team, standardized communication, and regular feedback to streamline workflows. Data from pre-intervention (July 1–September 30, 2014, Q1) were compared to post-intervention (October 1, 2014–June 30, 2015, Q2–Q4). The primary outcomes included the door-to-needle time and its changes, the proportion of patients receiving intravenous thrombolysis, and the percentage of patients achieving a door-to-needle time <60 min. Results A total of 2,059 acute ischemic stroke patients were included, with 535 in the pre-intervention period and 1,524 in the post-intervention period. Following the intervention, the median door-to-needle time significantly decreased from 73 to 63 min ( p = 0.001); however, the thrombolysis rate remained statistically unchanged, with rates of 63.0% pre-intervention and 63.5% post-intervention ( p = 0.849). Moreover, when the post-intervention period was subdivided into three quarters (Q2–Q4), there was a consistent downward trend in the median door-to-needle time (P for trend = 0.001). In addition, the percentage of patients achieving a door-to-needle time of less than 60 min increased from 31.5 to 40.5% ( p = 0.003). Conclusion Hospital process reengineering significantly improved door-to-needle time, highlighting the importance of optimizing workflows in acute stroke care. Although this study was conducted a decade ago, its findings continue to offer valuable insights and practical implications for underdeveloped regions and countries. Clinical trial registration Clinicaltrials.gov , NCT02631317 ( https://clinicaltrials.gov/study/NCT02631317 ).