Reducing Door-to-Needle (DTN) Time to Under 30 Minutes for Acute Stroke Cases: A Quality Improvement Project Protocol

Abstract

Abstract Background: The effectiveness of stroke treatment depends on time, the earlier the intervention, the greater the patient's chances of survival without disabilities. Medical intervention should be made within 4.5 hours of the onset of symptoms, after which, treatment will not be effective. The global standard was established in 1997, aiming to reach a door-to-needle (DTN) time of under 60 minutes. Unfortunately, this standard has not yet been updated. Nonetheless, some quality improvement (QI) projects have had great successes in reducing DTN time to under 30 minutes to improve quality and patient safety. Objective: The goal was to create a protocol that reduces DTN time from 60 minutes to less than 30 minutes for stroke patients, as well as improving patient outcomes and reducing the length of hospital stay and healthcare costs. Methods: An electronic search was conducted from July 2020 to August 2020 in the EMBASE, CINAHL, OVID, JBI, PubMed, MEDLINE, and Google Scholar databases, selecting sixteen studies. The quality of the studies was assessed using the CASP tool. Strategies, methods, and interventions used to reduce DTN time were identified. The Lean Six Sigma method was used to improve workflow, change patient pathways, and eliminate unnecessary steps. Results: Four main topics were identified across the sixteen studies, mainly factors associated with in-hospital delays in treating stroke patients, effects of delayed DTN on patient outcomes, strategies to reduce DTN time, and the effectiveness of various interventions to reduce DTN time. However, there were differences in the methods of interventions, problem-solving, the methodology used, and study outcomes. Conclusion: The findings from the literature support the development of different plans, strategies and methods in the improvement process to reduce the DTN time to under 30 minutes for stroke patients. Strategies extracted from the literature included reorganising hospital workflow, eliminating unnecessary steps, changing patient pathways, and improving staff collaboration and training. No single method was identified that works well on its own and achieving success depends on continuous improvement. The Lean Six Sigma method for process optimisation was used in the proposed plan to reduce DTN time to under 30 minutes to achieve success and long-term sustainability.