Improvement of door-to-imaging time in acute stroke patients by implementation of an all-points alarm

Abstract

In patients with acute ischemic stroke, thrombolysis offers an opportunity to effectively reduce disability and dependency. The success of this treatment is time-dependent. The crucial diagnostic step before initiation of treatment is cerebral imaging. With the aim of reducing in-hospital delays, our hospital's interdisciplinary stroke management group implemented an all-points alarm to improve in-hospital time delay (the period between arrival to the emergency department and performance of cerebral imaging). The alarm simultaneously alerted all involved staff (from the neurologist to in-hospital transport) to the arrival of a patient potentially eligible for thrombolysis. Time delay, sociodemographic, and clinical data were assessed prospectively at 4 months before and 8 months after alarm implementation. Data were examined by analysis of covariance for both the intention-to-treat and per-protocol groups. During the assessment, 689 patients with symptoms compatible with stroke arrived at our hospital. Among those, 111 patients (16%) were eligible for thrombolysis (median age, 71 years; median National Institutes of Health Stroke Scale score, 11; 44% female). Patient characteristics (ie, age, sex, insurance status, National Institutes of Health Stroke Scale score, cardiovascular risk factors, and prehospital delay) did not differ significantly before (n = 34) and after (n = 77) alarm implementation. The median "door-to-imaging time" for patients eligible for thrombolysis was significantly reduced, from 54 minutes before implementation of the alarm to 35 minutes after implementation. Adjusted analysis of covariance demonstrated a significant influence of the intervention (P = .001) on differences in time delay. The proportion of ischemic stroke patients receiving thrombolysis rose from 42% to 66% (P = .04). The per-protocol analysis confirmed these results. The implementation of an all-points alarm can result in significant reduction of the time needed for in-hospital pathways for acute stroke patients.