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Nursing-Led Quality Improvement Project Achieves 30-Minute Door-to-Needle Time
Journal article   Peer reviewed

Nursing-Led Quality Improvement Project Achieves 30-Minute Door-to-Needle Time

Kayla Powell, Abigail Hebb and Christopher T Hackett
Journal of emergency nursing, v 52(3)
21 Nov 2025
DOI: https://doi.org/10.1016/j.jen.2025.10.013
PMID: 41269200

Abstract

Stroke alert Door-to-needle time Telestroke Quality improvement
Despite efforts made within the emergency department, delays in intravenous thrombolytic time via telestroke remain.INTRODUCTIONDespite efforts made within the emergency department, delays in intravenous thrombolytic time via telestroke remain.A quality improvement project streamlined stroke care, focusing on workflow optimization, education, improved communication, and real-time feedback, aiming to reduce door-to-needle time.METHODSA quality improvement project streamlined stroke care, focusing on workflow optimization, education, improved communication, and real-time feedback, aiming to reduce door-to-needle time.A retrospective analysis revealed a reduction in door-to-needle time of 18.05 minutes (95% CI, 7.70-28.41; P = .001) was achieved. Achievement of door-to-needle time goals (30, 45, and 60 minutes) was met after implementation (adjusted P < .005). A higher proportion of intravenous thrombolytic rates occurred after implementation (45 [14.0%] vs 79 [8.1%]; adjusted odds ratio, 1.91; 95% CI, 1.29-2.84; P = .001).RESULTSA retrospective analysis revealed a reduction in door-to-needle time of 18.05 minutes (95% CI, 7.70-28.41; P = .001) was achieved. Achievement of door-to-needle time goals (30, 45, and 60 minutes) was met after implementation (adjusted P < .005). A higher proportion of intravenous thrombolytic rates occurred after implementation (45 [14.0%] vs 79 [8.1%]; adjusted odds ratio, 1.91; 95% CI, 1.29-2.84; P = .001).A telestroke-enabled primary stroke center consistently achieved <30-minute door-to-needle time through a nurse-led workflow emphasizing early stroke alert and computed tomography.DISCUSSIONA telestroke-enabled primary stroke center consistently achieved <30-minute door-to-needle time through a nurse-led workflow emphasizing early stroke alert and computed tomography.

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