Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening

Abstract Objective To determine the effects of a 1-year quality-improvement (QI) process to reduce door-to-needle (DTN) time in a secondary general hospital in which multimodal MRI screening is used before tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke (AIS). Methods The QI process was initiated in January 2015. Patients who received intravenous (iv) tPA  n  = 130), and their demographic and clinical characteristics and timing metrics compared with those of patients treated by iv tPA in 2014 (the “2014 cohort”, n  = 135). Results Of the 130 patients in the 2015 cohort, 120 (92.3%) of them were screened by MRI. The median DTN time was significantly reduced by 30% (from 84 min in 2014 to 59 min; P P P  P  ≤ 0.04) with a non-significant 1.5-fold increase in the proportion of treated patients with a DTN time ≤ 60 min (from 41% to 62%; P  = 0.09). Conclusion It is feasible to deliver tPA to patients with AIS within 60 min in a general hospital, using MRI as the routine screening modality, making this QI process to reduce DTN time widely applicable to other secondary general hospitals.