A Stroke Code and cooperation between doctors and nurses could reduce door-to-needle time for acute ischemic stroke

Abstract

The authors investigated that the impact of a Stroke Code and cooperation between doctors and nurses on door-to-needle (DTN) time in acute ischemic stroke patients anticipated to receive intravenous recombinant tissue-type plasminogen activator therapy (IV tPA). Nurses held study meetings about acute stroke care with the nurses in the emergency department, radiological technologists and stroke neurologists and neurosurgeons. After the meetings, we implemented the Stroke Code with the aim of achieving rapid stroke assessment and treatment. We included patients treated with IV tPA during pre-Stroke Code period, retrospectively and during the Stroke Code period, prospectively. The patients underwent magnetic resonance imaging (MRI) unless they had contraindications for MRI. The IV tPA time intervals, laboratory findings, imaging findings and outcomes (modified Rankin Scale [mRS] score 0 to 1 and mortality) at discharge and 90 days were corrected. Of the 153 patients, 82 patients received IV tPA under the Stroke Code. After the implementation of the Stroke Code, Completion of imaging-to-needle time and DTN time were significantly reduced by 6 and 8 minutes. However, there were no difference in the outcomes at discharge (mRS score 0 to 1; p=0.232 and mortality; p=0.251) and 90 days (mRS score 0 to 1; p=1.000 and mortality; p=0.548). We demonstrated that the implementation of Stroke Code and cooperation between doctors and nurses could improve the DTN time.