Abstract TP224: Moving the Door-to-Needle: Structured Process Improvements Reduce Acute Ischemic Stroke Treatment Times

Introduction: Rapid fibrinolytic administration in acute ischemic stroke (AIS) improves outcomes, with guidelines recommending door-to-needle (DTN) times ≤30 minutes for eligible patients. In 2023, only 16.7% of DTN times at our center met this target. Methods: A quality improvement project was conducted at a high-volume, comprehensive stroke program. Using the Plan-Do-Study-Act (PDSA) model, multiple coordinated interventions were implemented, including a standardized PLAN–SCAN–CAN triage mnemonic to expedite CT imaging and thrombolytic delivery. All thrombolytic-eligible AIS patients from 2023 through year-to-date 2025 were analyzed. DTN performance was categorized into ≤60, ≤45, and ≤30 minutes. Proportions and sample sizes were tracked annually. Results: From 2023–2024, DTN improvements were +9.2% (≤60 min), +8.4% (≤45 min), and +52.5% (≤30 min). By 2025 YTD, gains reached +11.8% (≤60 min), +26.7% (≤45 min), and +83.3% (≤30 min) compared to 2023 baseline. The greatest improvement occurred in the ≤30-minute category. While improvements aligned with the PLAN tool rollout, multiple concurrent changes prevent pinpointing a single intervention as a primary driver. Conclusion: In conclusion, structured intradisciplinary governance, standardized triage protocols, and multidisciplinary process reviews were associated with substantial and sustained reductions in DTN times, particularly achieving the ≤30-minute goal. Continuous evaluation and coordinated interventions are essential for sustaining performance gains.