Stroke nurse-led intravenous thrombolytic therapy strategy for ischemic stroke based on timeline process: A quality improvement program from China.
Baiyu Li, Zhufeng Zhang, Keye Li and 2 others
PMID 39698137WHAT IT FOUND
After a nurse-led stroke process with QR-code timing and ISBAR communication, median door-to-needle time fell from 46 to 30 minutes in a single-center quality improvement study.
Key findings
01Median door-to-needle time was 30 minutes in the standardized process group and 31 minutes in the added incentive group, compared with 46 minutes before the intervention.
02The proportion treated within 45 minutes rose from 47.1% before to 88.5% and 83.1% after the process.
03Adding an incentive policy did not produce a significant further reduction in door-to-needle time compared with the standardized process alone.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center study, so results may not transfer to other hospitals or health systems. The pre-intervention group was a historical control, not a randomized comparison, so secular improvements in stroke care could explain some gains. The intervention bundled many changes, including QR-code timing, nurse-led coordination, fast green channel, portable thrombolysis kits, ISBAR communication, and incentives; the study cannot separate which parts mattered. The added incentive policy was not shown to improve times further, and the authors suggest COVID-19 may have affected the later period. The study measured process times, not clinical outcomes such as survival, disability, length of stay, or costs.
Declared interests
The study was funded by a Zhejiang Provincial Medical and Health Science and Technology Plan Project, and the authors state the funder had no role in design, implementation, or analysis. The authors declare no conflict of interest.
The easy way to misread this
Do not read the drop from 46 to 30 minutes as proof that nurses alone speed thrombolysis. The intervention bundled many changes and used historical controls, and the added incentive did not significantly reduce DNT further.