Background: Timely intervention is critical in acute ischemic stroke, particularly for patients needing endovascular therapy. Delays in team activation and fragmented communication can hinder door-to-device times, impacting outcomes and performance. In our organization, traditional methods—phone calls, pagers, overhead announcements—created bottlenecks across the multidisciplinary stroke team, making it difficult to consistently meet the American Heart Association benchmark for door-to-device times in patients treated within six hours of last known well. Methods: Using Lean Six Sigma methodology, our team mapped the stroke activation process with a swim lane diagram, revealing redundancies and inefficiencies. The largest bottleneck was the stroke neurology resident’s need to make up to 12 separate phone calls per case. We partnered with our regional stroke consortium to select and implement a secure, HIPAA-compliant mobile communication platform enabling real-time, two-way communication across all departments and prehospital EMS. Implementation included standardized workflows, defined roles, auto-alerts, simulation training, and a region-wide rollout. We performed a 40-month retrospective review of Get With The Guidelines data, comparing key metrics—including door-to-device—pre- and post-implementation. Team feedback on usability and workflow impact was also collected. Results: Ten quarters of data were analyzed for patients within the six-hour treatment window. Within eight weeks of platform launch, over 50% of eligible patients achieved door-to-device times under 90 minutes (ED arrivals) and under 60 minutes (direct transfers). These gains were sustained for the remaining three quarters of 2024. The platform provided real-time access to key information—symptoms, last known well, imaging status, PHI—and pre-arrival alerts allowed early registration, CT readiness, and IR suite preparation. A single in-app action could activate the entire thrombectomy team, replacing multiple calls and manual coordination. Conclusion: Adopting a mobile communication platform improved stroke team efficiency and reduced treatment delays for endovascular therapy. By streamlining communication, enhancing situational awareness, and enabling earlier mobilization, the platform supported sustained improvements in door-to-device performance, helping preserve brain tissue in time-sensitive stroke care.
Onyan et al. (2026) studied this question.