Evaluation of the effect of provincial and municipal emergency green channels (post-informatization and process optimization) on the treatment of acute ischemic stroke and study on influencing factors such as DNT and DPT

This study evaluates the impact of informatization and process optimization on the treatment efficacy of the emergency green channel for acute ischemic stroke (AIS) in provincial and municipal hospitals and analyzes its key influencing factors. A retrospective cohort study was conducted, enrolling patients with AIS who received reperfusion therapy via the emergency green channel from September 1, 2024, to August 31, 2025. Patients were divided into a control group (pre-optimization, n = 50) and a study group (post-optimization, n = 50) based on whether the informatization optimization was implemented (“Stroke One-Click Start,” full-process electronic timestamps, cloud imaging platform, point-of-care rapid testing, and parallel pathways). Propensity score matching was used to balance baseline characteristics. The door-to-needle time (DNT), door-to-puncture time (DPT), compliance rates for key time nodes, clinical prognosis, and safety indicators were compared between the 2 groups. Baseline characteristics were balanced between the 2 groups after matching. The median DNT in the study group was significantly shorter than that in the control group (42 vs 68 minutes, P < .001), and the median DPT was also significantly shortened (92 vs 128 minutes, P < .001). The compliance rate for DNT ≤ 45 minutes increased from 22.0 to 70.0% ( P < .001), and the compliance rate for DPT ≤ 90 minutes increased from 16.0 to 48.0% ( P < .001). The times for key nodes (e.g., door-to-CT completion time, CT completion-to-treatment time) were significantly shortened (all P < .001). The study group had a higher proportion of favorable outcomes (mRS 0–2) at discharge and at 90 days (58.0 vs 36.0%, P = .027; 64.0 vs 44.0%, P = .046), and a shorter ICU stay ( P = .044), with no significant differences in safety indicators. Subgroup analysis showed that DNT was significantly shortened in all subgroups, and there was an interaction between NIHSS score and optimization effect ( P = .039), with the greatest benefit observed in patients with severe stroke. In this retrospective before-and-after cohort, implementation of the bundled informatization and process-optimization pathway was associated with shorter DNT and DPT, higher compliance with key time targets, and better functional outcomes without an observed increase in safety events. These findings should be interpreted in light of the nonrandomized design and support broader implementation in appropriately resourced institutions.