Shortening Door-to-Needle Time by Multidisciplinary Collaboration and Workflow Optimization During the COVID-19 Pandemic

Chen, Yimin; Nguyen, Thanh N; Wellington, Jack; Mofatteh, Mohammad; Yao, Weiping; Hu, Zhaohui; Kuang, Qiuping; Wu, Weijuan; Wang, Xuejun; Sun, Yu; Ouyang, Kexun; Xu, Junmiao; Huang, Weiquan; Yang, Shuiquan

Objectives: This study aims to evaluate shortening door-to-needle time of intravenous recombinant tissue plasminogen activator of acute ischemic stroke patients by multidisciplinary collaboration and workflow optimization based on our hospital resources. Materials and Methods: We included patients undergoing thrombolysis with intravenous recombinant tissue plasminogen activator from January 1, 2018, to September 30, 2020. Patients were divided into pre- (January 1, 2018, to December 31, 2019) and post-intervention groups (January 1, 2020, to September 31, 2020). We conducted multi-department collaboration and process optimization by implementing 16 different measures in prehospital, in-hospital, and post-acute feedback stages for acute ischemic stroke patients treated with intravenous thrombolysis. A comparison of outcomes between both groups was analyzed. Results: Two hundred and sixty-three patients received intravenous recombinant tissue plasminogen activator in our hospital during the study period, with 128 and 135 patients receiving treatment in the pre-intervention and post-intervention groups, respectively. The median (interquartile range) door-to-needle time decreased significantly from 57.0 (45.3-77.8) minutes to 37.0 (29.0-49.0) minutes. Door-to-needle time was shortened to 32 minutes in the post-intervention period in the 3(rd) quarter of 2020. The door-to-needle times at the metrics of ≤30 min, ≤45 min, ≤60 min improved considerably, and the DNT>60min metric exhibited a significant reduction. Conclusions: A multidisciplinary collaboration and continuous process optimization can result in overall shortened door-to-needle despite the challenges incurred by the COVID-19 pandemic.