Impact of emergency room meetings on improvement of door-to-needle times in acute ischemic stroke patients: A single center’s experience

Abstract

OBJECTIVE: One major limitation of the use of intravenous tissue plasminogen activator (IV-tPA) is the short treatmentwindow of acute ischemic stroke (AIS). In this article, we analyze the impact of emergency room meetings on step-by-stepimprovement of door-to-needle times (DTN).METHODS: This study used prospectively recorded data of AIS patients treated with IV-tPA admitted to the Sakarya UniversityEducation and Research Hospital between January 2015 and August 2017. Time benchmarks of DTN were recordedon a case-by-case basis. Meetings were held in the emergency room if there was an increase of more than 25% in DTN ofsubsequent AIS patients treated with IV-tPA. Guideline-recommended stroke management methods and feedback from ourprevious DTN data were both considered. The goal was to improve DTN within 60 minutes for at least 50% of AIS patients.RESULTS: Mean DTN of 20 patients was 76.9±32.4 minutes. Nine patients experienced ≤60 minute DTN times, while twowere under 30 minutes. Six meetings were conducted, with two each in 2015, 2016, and 2017. Without exception, therewas a reduction in DTN after all meetings. Considering the intervals of the six meetings, the ratios of patients treated at ≤60minutes were 0%, 0%, 60%, 66.6%, 40 and 100%, respectively.CONCLUSION: Meetings in the emergency room, when conducted according to certain rules, can be effective in improvingDTN.