Received : 17 May 2026
Accepted : 22 July 2026
Published : 26 July 2026
DOI: 10.30726/esij/v13.i3.2026.1330056
Reducing Door-to-Needle Time for Acute Ischaemic Strok Thrombolysis: An Eighteen-Month Quality Improvement Programme
Door-to-needle time (DNT) for intravenous thrombolysis in acute ischaemic stroke is one of the most carefully measured performance indicators in acute medicine, with each 10-minute reduction associated with approximately 1% absolute increase in patients achieving an independent functional outcome. We undertook a structured quality improvement programme at a tertiary stroke centre across 18 months, comparing 124 thrombolysis activations in the 6-month pre-QI baseline, 98 during the 6-month implementation phase, and 96 during the 6-month post-QI sustained phase. Median DNT fell from 78 minutes (IQR 64-104) pre-QI to 48 minutes (IQR 38-62) post-QI. The proportion achieving DNT below 60 minutes rose from 27% pre-QI to 76% post-QI. Ninety-day functional outcomes shifted substantially: modified Rankin scale 0-2 (independent) at 90 days rose from 53% pre-QI to 75% post-QI, and 90-day mortality fell from 8% to 2%. Strongest predictors of DNT <60 minutes included the post-QI phase, pre-notification by emergency medical services, stroke alert activation at the door, CT in the emergency department, and stroke nurse coordinator availability. The findings reproduce trial-equivalent DNT improvements in a real-world tertiary setting through structured operational redesign.[/mysc_spoiler]
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