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Original Article 


Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience

Mahmoud A Alshanqiti, Mohammed S Alqahtani, Naif F Alharbi, Mohammed M Alwadai, Muhannad A Asiri, Saeed A Alqahtani, Mosab A Alguthmi, Saeed Y. Ogran, Mohammed Almansour, Khalid Bajunaid, Saeed S Alzahrani.

Abstract
Background and Aims:
Thrombolysis has been shown to improve stroke outcomes by reducing disability, particularly when administered early. Lowering the door-to-needle time (DNT) for administering intravenous thrombol¬ysis (IVT) is an important objective for improving the quality of acute stroke care. This study aims to compare DNT before and after implementing the code stroke pathway protocol.
Methods:
The study evaluated the impact of a quality improvement project, Code Stroke, on acute ischemic stroke patients at King Fahd General Hospital in Jeddah, Saudi Arabia, September 2019 to April 2020, using a retrospective record-based analysis, with data extracted using a standardized format and cat¬egorized into pre and post code groups.
Results:
81 stroke patients were reviewed, with 47 in the pre-code group and 34 in the post-code group. The re¬ported tPA DNT time was less than 60 minutes in only 8.5% of patients before the implementation of stroke code activation, compared to 55.9% after implementation (p=.001). Incidence of symptomatic hemorrhagic transformation was 8.6%. Post-code group had a lower median length of hospital stay (8 days) compared to the pre-code (13 days), with a marginal trend towards statistical significance, and half of the post-code group patients had a modified Rankin Scale of 0-2 compared to one third of the pre-code group at three months of discharge.
Conclusions:
The Code Stroke project resulted in a significant reduction in DNT, improved functional outcomes, and a reduction in hospital length of stay, but the incidence of symptomatic intracranial hemorrhage and in-hospital mortality rates were slightly higher than expected, requiring continued improvement efforts.

Key words: Door to needle time, Length of hospital stay, Code stroke, Acute stroke


 
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How to Cite this Article
Pubmed Style

Alshanqiti MA, Alqahtani MS, Alharbi NF, Alwadai MM, Asiri MA, Alqahtani SA, Alguthmi MA, Ogran SY, Almansour M, Bajunaid K, Alzahrani SS. Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience. Majmaah J Heal Sci. 2023; 11(4): 85-97. doi:10.5455/mjhs.2023.04.009

Web Style

Alshanqiti MA, Alqahtani MS, Alharbi NF, Alwadai MM, Asiri MA, Alqahtani SA, Alguthmi MA, Ogran SY, Almansour M, Bajunaid K, Alzahrani SS. Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience. https://www.mjhs-mu.org/?mno=148925 [Access: December 16, 2023]. doi:10.5455/mjhs.2023.04.009

AMA (American Medical Association) Style

Alshanqiti MA, Alqahtani MS, Alharbi NF, Alwadai MM, Asiri MA, Alqahtani SA, Alguthmi MA, Ogran SY, Almansour M, Bajunaid K, Alzahrani SS. Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience. Majmaah J Heal Sci. 2023; 11(4): 85-97. doi:10.5455/mjhs.2023.04.009


Vancouver/ICMJE Style

Alshanqiti MA, Alqahtani MS, Alharbi NF, Alwadai MM, Asiri MA, Alqahtani SA, Alguthmi MA, Ogran SY, Almansour M, Bajunaid K, Alzahrani SS. Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience. Majmaah J Heal Sci. (2023), [cited December 16, 2023]; 11(4): 85-97. doi:10.5455/mjhs.2023.04.009


Harvard Style

Alshanqiti, M. A., Alqahtani, . M. S., Alharbi, . N. F., Alwadai, . M. M., Asiri, . M. A., Alqahtani, . S. A., Alguthmi, . M. A., Ogran, . S. Y., Almansour, . M., Bajunaid, . K. & Alzahrani, . S. S. (2023) Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience. Majmaah J Heal Sci, 11 (4), 85-97. doi:10.5455/mjhs.2023.04.009


Turabian Style

Alshanqiti, Mahmoud A, Mohammed S Alqahtani, Naif F Alharbi, Mohammed M Alwadai, Muhannad A Asiri, Saeed A Alqahtani, Mosab A Alguthmi, Saeed Y. Ogran, Mohammed Almansour, Khalid Bajunaid, and Saeed S Alzahrani. 2023. Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience. Majmaah Journal of Health Sciences, 11 (4), 85-97. doi:10.5455/mjhs.2023.04.009


Chicago Style

Alshanqiti, Mahmoud A, Mohammed S Alqahtani, Naif F Alharbi, Mohammed M Alwadai, Muhannad A Asiri, Saeed A Alqahtani, Mosab A Alguthmi, Saeed Y. Ogran, Mohammed Almansour, Khalid Bajunaid, and Saeed S Alzahrani. "Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience." Majmaah Journal of Health Sciences 11 (2023), 85-97. doi:10.5455/mjhs.2023.04.009


MLA (The Modern Language Association) Style

Alshanqiti, Mahmoud A, Mohammed S Alqahtani, Naif F Alharbi, Mohammed M Alwadai, Muhannad A Asiri, Saeed A Alqahtani, Mosab A Alguthmi, Saeed Y. Ogran, Mohammed Almansour, Khalid Bajunaid, and Saeed S Alzahrani. "Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience." Majmaah Journal of Health Sciences 11.4 (2023), 85-97. Print. doi:10.5455/mjhs.2023.04.009


APA (American Psychological Association) Style

Alshanqiti, M. A., Alqahtani, . M. S., Alharbi, . N. F., Alwadai, . M. M., Asiri, . M. A., Alqahtani, . S. A., Alguthmi, . M. A., Ogran, . S. Y., Almansour, . M., Bajunaid, . K. & Alzahrani, . S. S. (2023) Door to Needle Time in Acute Ischemic Stroke Patients before and after Initiation of Quality Improvement Project - Single Local Centre Experience. Majmaah Journal of Health Sciences, 11 (4), 85-97. doi:10.5455/mjhs.2023.04.009




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