To assess the effect of simultaneous acute code stroke activation (ACSA) in the emergency department on the door-to-needle (DTN) time of patients with acute ischemic stroke eligible for reperfusion therapies.

Simultaneous emergency call activations carry increased workload that could possibly compromise quality parameters and patient outcomes.

All ACSA from March 2021 to August 2022 from the QuICR (Quality Improvement and Clinical Research Alberta Stroke Program) Registry were assessed. We defined Simultaneity based on the Canadian Triage and Acuity Scale, average local DTN and door-to-puncture (DTP) times: ACSA 30 min prior to any patient receiving intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT); ACSA within 60 min of any patient receiving IVT and ACSA within 120 min of any patient receiving EVT. The simultaneity grade 1 was 2 patients care overlap as per simultaneous ACSA definition, grade 2 was 3 patients care overlap and grade 3 was >3 patients care overlap. Independent sample Kruskal-Wallis test was applied to assess the between-group differences in median treatment times.

496 patients (20.9%, n=2364) underwent acute reperfusion therapy with a mean±SD age of 70.4±14.6 years, 45%(n=224) were female and a median (IQR) NIHSS of 12 (10) during the study period. Simultaneous ACSA was 163 (32.9%). The median (IQR) DTN time in the non-simultaneous group(n=205), grades 1 (n=76), 2 (n=13) and 3 (n=4) simultaneities was 38 (22)min, 39.5 (21)min, 45 (26)min, 58.5 (19.5)min respectively (p=0.27).  The median (IQR) DTP time in the non-simultaneous group (n=187), in grades 1 (n=69), 2 (n=27) and 3 (n=6) simultaneities was 99 (42)min, 93 (48)min, 98 (39)min and 153 (112.75)min respectively (p=0.6).