040\u2005The quest to reduce stroke treatment delays at a melbourne metropolitan primary stroke centre over the last two decades

Abstract

Objectives To examine door-to-needle time (DNT) trends and the impact of continuous quality improvement initiatives since thrombolysis became standard of care in Australian metropolitan setting for eligible acute ischaemic stroke patients. Methods Single-centre retrospective cohort study of consecutive patients treated with thrombolysis at high volume primary stroke centre from January 2003 to December 2019. Primary outcomes are DNT, and annual number of ‘Code Stroke’ activations and stroke admissions. Regression modelling for potential factors associated with DNT. Results 1,250 patients were treated with thrombolysis over 17 years; 54% were male with a median age of 76 (interquartile ranges [IQR], 66–83). Median DNT fluctuated between 70 to 93 minutes (IQR, 55–95 to 82–120) from 2003 to 2012, reaching 60 minutes in 2013 and nadir of 47 minutes in 2014. Median DNT then decreased from 58 minutes in 2015 to 51 minutes in 2019 with progressive tightening of IQR (46–78 to 40–62). Number of patients treated within 60 minutes of hospital arrival was less than 30% between 2003-2012. This rose to an average of 63% during 2015–2018 and 71% in 2019. From 2015 to 2019, per annum number of ‘Code Stroke’ activations increased from 940 to 1300 while stroke admissions plateaued at 750. ‘Direct-to-CT’ protocol and acute stroke presence were two modifiable workflow factors independently associated with faster DNT (P Conclusion Targeted quality improvement initiatives are key to reducing treatment delays in the Australian metropolitan setting. Relative stagnation in DNT improvement is concerning and needs further investigation.