Supplementary file 7_Impact of hospital process reengineering on door-to-needle time for intravenous thrombolysis in acute ischemic stroke (PROMISE-CHINA): a multicenter prospective pre-post quasi-experimental study.docx

BackgroundIntravenous thrombolytic therapy significantly improves the prognosis of patients with acute ischemic stroke in a time-dependent manner. This study aims to evaluate the effectiveness of hospital process reengineering in reducing delays to intravenous thrombolysis in patients with acute ischemic stroke.
MethodsThis multicenter, prospective, nonrandomized quasi-experimental (pre-post) study included patients with acute ischemic stroke presenting within 3.5 h of symptom onset. Hospital process reengineering involved key measures such as pre-notification by emergency medical services, simultaneous activation of a multidisciplinary team, standardized communication, and regular feedback to streamline workflows. Data from pre-intervention (July 1–September 30, 2014, Q1) were compared to post-intervention (October 1, 2014–June 30, 2015, Q2–Q4). The primary outcomes included the door-to-needle time and its changes, the proportion of patients receiving intravenous thrombolysis, and the percentage of patients achieving a door-to-needle time <60 min.
ResultsA total of 2,059 acute ischemic stroke patients were included, with 535 in the pre-intervention period and 1,524 in the post-intervention period. Following the intervention, the median door-to-needle time significantly decreased from 73 to 63 min (p = 0.001); however, the thrombolysis rate remained statistically unchanged, with rates of 63.0% pre-intervention and 63.5% post-intervention (p = 0.849). Moreover, when the post-intervention period was subdivided into three quarters (Q2–Q4), there was a consistent downward trend in the median door-to-needle time (P for trend = 0.001). In addition, the percentage of patients achieving a door-to-needle time of less than 60 min increased from 31.5 to 40.5% (p = 0.003).
ConclusionHospital process reengineering significantly improved door-to-needle time, highlighting the importance of optimizing workflows in acute stroke care. Although this study was conducted a decade ago, its findings continue to offer valuable insights and practical implications for underdeveloped regions and countries.
Clinical trial registrationClinicaltrials.gov, NCT02631317 (https://clinicaltrials.gov/study/NCT02631317).