Improving Door-to-Treatment Times: The Role of an Integrated Simulation and Workflow Program in a Community Hospital's Acute Ischemic Stroke Care

BACKGROUND: Acute ischemic stroke requires rapid intervention to optimize patient outcomes, yet community hospitals often face challenges in minimizing door-to-needle time (DNT) and door-to-groin time (DGT). Simulation-based education offers a structured approach to enhancing workflow efficiency and interdisciplinary coordination. This quality improvement initiative evaluates the impact of a targeted simulation and workflow optimization program on stroke treatment times at a community hospital. METHODS: A quality improvement initiative was implemented at Northwest Community Hospital, part of the Endeavor Health System. The intervention consisted of 6 multidisciplinary simulation sessions conducted over 9 weeks to train emergency department and interventional radiology teams on an optimized stroke workflow. Pre- and postintervention data were collected on stroke response times from actual patient cases over 3 time periods: preintervention (12 months), during intervention (3 months), and postintervention (10 months). The primary outcome was DNT, with DGT as a secondary outcome. RESULTS: A total of 58 stroke cases were analyzed preintervention, 13 during intervention, and 70 postintervention. The mean DNT improved from 46 minutes preintervention to 39 minutes postintervention (P = 0.0209), whereas the mean DGT improved from 106 to 79 minutes (P = 0.0001). Simulation participants reported increased confidence in stroke response tasks, with postsession surveys indicating strong agreement in preparedness and safety measures. CONCLUSION: The integration of a structured simulation-based education program significantly reduced stroke treatment times in a community hospital setting. This initiative highlights the value of simulation in refining clinical workflows and improving time-sensitive emergency care. Further research is warranted to explore long-term patient outcomes and the broader applicability of this approach in nonacademic hospitals.