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Abstract Details

Significant Reduction in Door-to-CT and Door-to-needle Times by Streamlining Emergency Room Acute Stroke Protocols Through Interdisciplinary Collaboration
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (5:00 PM-6:00 PM)
4-013

To compare the door-to-CT (DTCT) and door-to-needle (DTN) times before and after implementation of a streamlined emergency department (ED) acute stroke protocol.

Time from symptom onset to reperfusion in acute ischemic stroke is a major determinant of infarct size and patient outcomes. Regular updates to existing stroke protocols should be performed to optimize workflow and incorporate new best practices. In early 2025, we revised our ED acute stroke protocol to expedite direct transfer from the triage area to the CT scanner and to administer tenecteplase (TNK) on the CT table for eligible patients.

In this observational, retrospective study we compared DTCT and DTN times for patients presenting to the ED with presumed acute ischemic stroke and who were treated with TNK during equivalent 6-month periods before (2024) and after (2025) implementation of the updated ED stroke protocol. T-tests were conducted to evaluate differences in DTCT and DTN needle time between the two periods.

We included 49 patients, 24 (49%) treated in a 6-month period in 2024, and 25 (51%) treated in 2025. Mean age was 69 (22-91 yrs), 63.3% were female. There was significant decrease in DTCT time from 26 min in 2024 (CI, 21-34.5) to 11 min in 2025 (CI, 9-15) which led to subsequent improvement in DTN times from 62 min (CI, 47.75-72.5) to 45 min (CI, 40-55; p=0.0146).  

Multidisciplinary collaboration and teamwork starting with Emergency Medical Services and involving ED staff and nursing, Neurology, Pharmacy, and Radiology can lead to significant decreased in DTCT and DTN times with the ultimate goal of improving outcomes for acute stroke patients.

Authors/Disclosures
Gabriella DiCarlo, MD, PhD (Mass General Brigham)
PRESENTER 		Dr. DiCarlo has nothing to disclose.
Suzete N. Farias Da Guarda, MD, PhD (Massachusetts General Hospital) Prof. Farias Da Guarda has nothing to disclose.
Nupur N. Goel, MD (Alcott Apartments) Dr. Goel has nothing to disclose.
Ashwin Amurthur, MD (Home) Dr. Amurthur has nothing to disclose.
Lauren M. Nentwich, MD Dr. Nentwich has nothing to disclose.
Michael H. Lev, MD (Mass General Hospital) Michael H. Lev, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Takeda, Roche-Genetech. The institution of Michael H. Lev, MD has received research support from GE. Michael H. Lev, MD has received publishing royalties from a publication relating to health care.
Lanting Fuh, PharmD Miss Fuh has received publishing royalties from a publication relating to health care.
Kori Zachrison, MD Dr. Zachrison has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Circulation: Cardiovascular Quality and Outcomes. Dr. Zachrison has received publishing royalties from a publication relating to health care.
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital) An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (好色先生) with Biogen.
Barbara Voetsch, MD, PhD (Massachusetts General Hospital) The institution of Dr. Voetsch has received research support from NIH StrokeNet . Dr. Voetsch has received publishing royalties from a publication relating to health care. Dr. Voetsch has received personal compensation in the range of $500-$4,999 for serving as a International Stroke Conference attendee (travel-related expenses) with AHA/ASA. Dr. Voetsch has a non-compensated relationship as a member of the Massachusetts Systems of Care Workgroup with AHA/ASA that is relevant to AAN interests or activities.