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Improving Door-to-needle Times in the Treatment of Acute Ischemic Stroke Across a Canadian Province


Kamal, Noreen, PhD*; Jeerakathil, Thomas, MD, MPH; Mrklas, Kelly, MSc; Smith, Eric E., MD, MPH*,§; Mann, Balraj, MS, MBA; Valaire, Shelley, MA; Hill, Michael D., MD, MSc*,§ for the QuICR Alberta Stroke Program

Critical Pathways in Cardiology: March 2019 - Volume 18 - Issue 1 - p 51–56
doi: 10.1097/HPC.0000000000000173

Background: Alteplase is a proven medical treatment for acute ischemic stroke; however, the effectiveness of this treatment is highly time dependent. Therefore, it is imperative that hospitals treat acute ischemic stroke patients as quickly as possible. The measure, door-to-needle time, is the time from hospital arrival to when alteplase administration begins.

Objective: The goal in the Canadian province of Alberta was to reduce the door-to-needle time to a median of 30 minutes and to increase the percent of patients treated within 60 minutes to 90%.

Overview of Methodology: A modified version of Institute for Healthcare Improvement Breakthrough Series Collaborative was used. All stroke centers self-enrolled into the collaborative after initial contact, and sites created interdisciplinary teams to participate in the Collaborative. Leadership and faculty were highly experienced in quality improvement and acute stroke. There were 3 daylong face-to-face learning sessions that were attended by enrolled teams, which included presentation about the evidence, site presentations to promote cross-site learning, and time to plan changes with their teams. The sites were also supported by site visits, webinars, and data feedback.

From the *Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB

Division of Neurology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB

Research Innovation and Analytics, Alberta Health Services, Calgary, AB

§Hotchkiss Brain Institute, University of Calgary, Calgary, AB

Cardiovascular Health and Stroke: Strategic Clinical Network, Alberta Health Services, Edmonton, AB.

Received for publication July 9, 2018; accepted September 17, 2018.

Reprints: Noreen Kamal, PhD, HBA 2938, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB T2N 4N1. E-mail:

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