Practical Steps to Improve Timeliness of Acute Stroke Thrombolysis

Richard D. Zane, MD, FAAEM

Implementing three components of the Helsinki stroke model reduced median door-to-needle time by 20 minutes at an Australian hospital.

Helsinki University Central Hospital achieved a median door-to-needle time of 20 minutes for acute stroke patients arriving by ambulance, by implementing 12 separate interventions (NEJM JW Emerg Med Aug 17 2012). In May 2012, a hospital in Australia implemented three Helsinki interventions during weekday office hours — stroke team activation based on emergency medical services notification, direct patient transfer from ambulance to computed tomography (CT), and initiation of tissue plasminogen activator in the CT room; these authors prospectively analyzed the effect of these interventions on door-to-needle time.

Median door-to-needle time decreased from 61 minutes during the year before the intervention (85 patients) to 46 minutes during the 8 months after (48 patients). All the reduction was attributable to patients who presented during office hours; in this group, median door-to-needle time decreased from 43 to 25 minutes. For patients who presented at other times, there was no change in time to treatment.

Citation(s):

Meretoja A et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology 2013 Sep 17; 81:1071