Background and purpose: Improving   door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke   patients improves outcomes, but participation in DNT improvement initiatives   has been mostly limited to larger, academic medical centers with an existing   interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a   provincial improvement collaborative intervention on improvement of DNT and   patient outcomes. 

Results:   Two thousand four hundred eighty-eight ischemic stroke patients received   thrombolysis in the pre- and postintervention periods (630 in the post   period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs   were reduced from a median of 70.0 minutes (interquartile range, 51-93) to   39.0 minutes (interquartile range, 27-58) for patients treated per guideline   (P<0.0001). The percentage of patients discharged home from acute care   increased from 45.6% to 59.5% (P<0.0001); the median 90-day home time   increased from 43.3 days (interquartile range, 27.3-55.8) to 53.6 days   (interquartile range, 36.8-64.6) (P=0.0015); and the in-hospital mortality   decreased from 14.5% to 10.5% (P=0.0990). 

Conclusions: The improvement collaborative was likely the key contributing   factor in reducing DNTs and improving outcomes for ischemic stroke patients   across Alberta.

Authors: Noreen Kamal, Thomas Jeerakathil, Jillian Stang, Mingfu Liu, Edwin Rogers, Eric E. Smith, Andrew M. Demchu, Muzaffar Siddiqui, Balraj Mann, Jennifer Bestard, Eddy Lang, Elaine Shand, Magali Benard, Lisa Collins, Kevin Martin, Corinna Hartley, Marnie Reiber, Shelley Valaire, Kelly J. Mrklas, Michael D. Hill