Good is not Good Enough: The Benchmark Stroke Door-to-Needle Time Should be 30 Minutes

The quality of treatment of hyperacute ischemic stroke in Canada: a retrospective chart audit

“…23 Thus, one can argue even 60 minutes is too long a wait, and we have called for a concerted national effort to reduce in-hospital times to 30 minutes or less. 24 In Helsinki, (Table 3), we can expect that Canadian patients who receive thrombolysis will fare substantially worse than their Finnish counterparts. Whereas the smaller land area of Finland may facilitate faster transport to hospital compared with the more widely spread populations served in Canada, we should be able to replicate Helsinki's success with arrival to treatment intervals by optimizing inhospital processes.…”

Visualizing Acute Stroke Data to Improve Clinical Outcomes

“…We lowered our goal from 45 to 30 minutes when we started our new improvement initiative, as our visualization showed that we were often successful in meeting our previous goal. 3 The excel workbook that was used to create these charts can be found at http://www.ucalgary.ca/quicr/files/quicr/sample-stroke-visualization-worksheet.xls. It is freely available.…”

“…1 Reducing the variance and improving door-toneedle (DTN) time for thrombolysis and time from computed tomography (CT)-to-groin puncture for endovascular therapy will improve outcomes for patients with stroke. [1][2][3][4][5] Therefore, reducing variance and improving treatment times are critical components for quality assurance efforts in stroke care. Feedback of DTN performance data has been used in quality improvement initiatives for acute stroke treatment.…”

Imaging, Intervention, and Workflow in Acute Ischemic Stroke: The Calgary Approach

“…6 Specialized stroke centers have successfully reduced their door-to-needle time for IV rtPA to 20 minutes; there is a call for a new benchmark door-to-needle time of Ͻ30 minutes. 7 Because the recent endovascular trials demonstrate that fast reperfusion is the key to a good outcome, metrics such as onset-to-reperfusion time and imaging-to-reperfusion time will gain importance.…”