A quality improvement project to minimise door to needle time in acute ischaemic stroke patients at a quaternary hospital, Kochi, India

Despite existing guidelines, the recommended door to needle time1 for acute ischemic stroke patients was not consistently met. This Quality Improvement Project aims to analyse barriers and propose interventions to achieve timely thrombolysis. 1. Facilitate early thrombolysis in eligible patients. 2. Improve the stroke code pathway. 3. Establish a standardised hospital protocol for acute ischemic stroke patients within the thrombolysis window period. This quality improvement project included all acute ischaemic stroke patients presenting within the thrombolysis window period.2 A 6-month audit, comprising both retrospective and prospective data collection, was conducted using electronic medical records (EMR) and the stroke register. The intervention involved streamlining processes to facilitate early thrombolysis, improving the stroke code pathway, and establishing a standardised hospital protocol. Statistical analysis, including the Mann-Whitney U test, was employed to evaluate the impact of the intervention on door to needle time. Implementation of three key recommendations has significantly improved acute ischaemic stroke management. Firstly, a protocol now records symptom onset, door to imaging, and door to needle time, ensuring prompt decision-making. Secondly, stroke-focused Continuing Medical Education sessions enhance staff awareness and skills. Lastly, neurology consultants provide direct guidance on imaging studies, expediting diagnostic evaluation. These measures streamline processes, reduce delays, and optimise patient outcomes. The study investigated the impact of the intervention on door to needle time across two phases. Phase I demonstrated a mean door to needle time of 90.33 min, which significantly decreased to 62.16 min in Phase II. This indicates the effectiveness of the intervention in reducing door to needle time and improving efficiency in patient care. The findings suggest that targeted quality improvement initiatives, such as process optimisation and protocol establishment, are crucial in optimising acute stroke management and enhancing treatment outcomes. In conclusion, the implementation of targeted interventions led to a significant improvement in door to needle time for acute ischaemic stroke patients. By addressing barriers and streamlining processes, the project achieved its objective of optimising patient care and treatment efficacy. These findings underscore the importance of continuous quality improvement efforts in healthcare settings to ensure timely and effective management of acute ischaemic stroke.