You do realize that door to needle time is the wrong metric to be using as a goal? It has to be needle time after stroke. Can you get it within 3 minutes as this research in mice suggests is needed?
In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.
Electrical 'storms' and 'flash floods' drown the brain after a stroke
NO, then what the hell are you doing after the needle stick to get your patients 100% recovered? NOTHING? Then you're allowing millions to billions of neurons to die because of the neuronal cascade of death.
Impact of emergency department arrival time on door-to-needle time in patients with acute stroke
Latha Ganti1,2,3,4*, 
Amber Mirajkar4, Paul Banerjee3,4, Tej Stead5, Andrew Hanna6, Joshua Tsau7, Mohammed Khan4 and Ankur Garg1,4- 1Department of Neurology, University of Central Florida College of Medicine, Orlando, FL, United States
- 2Department of Emergency Medicine, University of Central Florida College of Medicine, Orlando, FL, United States
- 3Polk County Fire Rescue, Bartow, FL, United States
- 4HCA Florida Osceola Hospital, Kissimmee, FL, United States
- 5Department of Mathematics and Physics, Brown University, Providence, RI, United States
- 6Division of Pediatric Emergency Medicine, University of Florida, Jacksonville, FL, United States
- 7Department of Emergency Medicine, UT San Antonio, San Antonio, TX, United States
Background: This study aimed to identify which emergency department (ED) factors impact door-to-needle (DTN) time in acute stroke patients eligible for intravenous thrombolysis. The purpose of analyzing emergency department factors is to determine whether any modifiable factors could shorten the time to thrombolytics, thereby increasing the odds of improved clinical outcomes.
Methods: This was a prospective observational quality registry study that included all patients that received alteplase for stroke. These data are our hospital data from the national Get With The Guidelines Registry. The Get With The Guidelines® Stroke Registry is a hospital-based program focused on improving care for patients diagnosed with a stroke. The program has over five million patients, and hospitals can access their own program data. The registry promotes the use of and adherence to scientific treatment guidelines to improve patient outcomes. The time of patient arrival to the ED was captured via the timestamp in the electronic health record. Arriving between Friday 6 p.m. and Monday 6 a.m. was classified as “weekend,” regardless of the time of arrival. Time to CT, time-to-lab, and presence of a dedicated stroke team were also recorded. Emergency medical services (EMS) run sheets were used to verify arrival via ambulance.
Results: Forty-nine percent of the cohort presented during the day shift, 24% during the night shift, and 27% on the weekend. A total of 85% were brought by EMS, and 15% of patients were walk-ins. The median DTN time during the day shift was 37 min (IQR 26–51, range 10–117). The median DTN time during the night shift was 59 min (IQR 39–89, range 34–195). When a dedicated stroke team was present, the median DTN time was 36 min, compared to 51 min when they were not present. The median door-to-CT time was 24 min (IQR 18–31 min). On univariate analyses, arriving during the night shift (P < 0.0001), arriving as a walk-in (P = 0.0080), and longer time-to-CT (P < 0.0001) were all associated with longer DTN time. Conversely, the presence of a dedicated stroke team was associated with a significantly shorter DTN time (P < 0.0001).
Conclusion: Factors that contribute most to a delay in DTN time include arrival during the night shift, lack of a dedicated stroke team, longer time-to-CT read, and arrival as a walk-in. All of these are addressable factors from an operational standpoint and should be considered when performing quality improvement of hospital protocols.
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