ITimeliness & access

Door-to-needle time (acute stroke)

Time from arrival to starting IV thrombolysis in an eligible acute ischaemic stroke. The brain loses ~1.9 million neurons a minute during a large-vessel stroke, so this clock is measured in saved or lost function.

Capture & escalation pipeline

From stroke recognition to thrombolysis, with the segmented breach review.

How it’s measured

Numerator: Eligible acute ischaemic stroke patients who receive IV thrombolysis within the target door-to-needle time.
Denominator: All thrombolysed acute ischaemic stroke patients.
Formula: (Numerator ÷ Denominator) × 100, reported with median door-to-needle minutes.
Unit: % within target (and median minutes)

Target

India

India: Aim for door-to-needle ≤60 minutes, with leading stroke-ready centres pushing toward ≤45 minutes; tracked in NABH stroke-pathway audits.

Global

International: AHA/ASA 'Target: Stroke' — ≤60 minutes, with ambitious goals of ≤45 and ≤30 minutes in a majority of patients.

Report the median and the proportion under 60 min — both, because a single fast case does not make a fast pathway.

Who does what

The clinical chain of responsibility at the bedside.

Triage nurse	Recognises stroke symptoms (FAST/BE-FAST), records last-known-well time, and activates the stroke pathway at the door.
ED doctor	Does the focused exam/NIHSS, orders and interprets the urgent CT, confirms eligibility and consents.
Radiology / CT technician	Prioritises the stroke CT and reports door-to-CT and CT-to-report times.
Nursing	Establishes IV access, sends bloods, and administers the thrombolytic on the order; records the needle time.

What to capture & how it’s automated

Who captures it

ED doctor and nursing, with radiology contributing CT timestamps.

What is captured

Arrival time, last-known-well, door-to-CT, CT-to-decision, and needle (bolus) time.

Manual reality

Times scattered across the case sheet, CT register, and nursing notes; reconciled by hand and frequently incomplete for the last-known-well and decision steps.

Automated in real life

A stroke-pathway form in the EMR with timestamped checkpoints, CT timings pulled from RIS/PACS, and a dashboard that breaks the interval into door-to-CT, CT-to-decision, and decision-to-needle so the slow step is visible.

Who in the hospital is involved

Beyond the bedside — the functions that make capture and improvement happen.

Stroke coordinator / QI nurse	Audits every thrombolysis case, segments the delay, and runs case review.
Radiology	Owns door-to-CT and CT-report turnaround for the pathway.
Medical records / HIM	Extracts the timestamp set and links it to outcome data.
IT	Builds the EMR stroke form and the interval dashboard.
Pharmacy	Keeps the thrombolytic immediately available and weight-based dosing ready.
Neurology / physician lead	Owns eligibility decisions and the feedback loop on outcomes.

Why it affects performance

Door-to-needle is the signature metric of a stroke-ready ED and a NABH/board-level quality marker. Breaking it into door-to-CT and decision-to-needle exposes exactly where the system stalls.

Why it affects patient care

Faster thrombolysis means more patients walk out independent rather than disabled. Every minute saved is brain saved — the indicator is a direct proxy for long-term function and survival.

Capture pitfalls & gaming to watch for

Missing or guessed last-known-well time, which determines eligibility.
Measuring only the total interval and not the door-to-CT vs decision-to-needle split, hiding the real bottleneck.
Counting non-eligible or mimics in the denominator.
Stopping the clock at 'decision' rather than actual bolus administration.

What actually moves the number

Pre-notification from ambulance and a one-call stroke activation.
Direct-to-CT pathway from triage, bypassing a separate ED bay.
Thrombolytic and weight-based dosing pre-staged at the bedside.
Parallel rather than sequential steps (bloods, consent, CT booking together).
Feedback of segmented times to the team after every case.

References

Freely citable

Compiled from contemporary emergency-medicine quality practice and freely citable accreditation and guideline standards. Educational use only.