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Door-To-Needle Time Theory

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When a person suffers from a stroke, there is limited time frame to provide lifesaving interventions to that individual. The recommended door-to-needle time for a patient in need of tissue Plasminogen activator (tPA) administration, for treatment of an ischemic stroke, is one hour. Within this time period, the affected individual must be brought into the Emergency Department (ED) from the ambulance and registered. They are then required to have a full set of vitals taken, as well as a CNS assessment done by the Registered Nurse and ED Physician. Blood work is then taken and while the patient is sent to CT scan, the blood is processed. Once the CT is completed the patient is then assessed by the neurologist. The patient can then receive the …show more content…

That is twenty-three minutes over the average time it takes to administer the lifesaving medication. With tPA administration every minute counts. An average of 1.9 million brain cell die every minute when there is oxygen deprivation. In NBRHC there are several barriers that are contributing to the high door-to-needle time. There is a recognizable need for change for this process if it taking twenty-three minutes longer than the average administration time in other hospital regions. It is vital that NBRHC investigates into their current process to determine how they can reduce the door-to-needle time, to increase not only the patients chance of survival, but prevent as much damage from taking place as …show more content…

Which was to increase patient survival rate. They were eager to offer support and suggestions to improve the stroke protocol. This was accomplished by allowing all team members to have a clear understanding of the end result.
One of the major concerns in the door-to-needle administration process was the diagnostic imaging. Unfortunately, due to limited resources and staff, due to cutbacks, there is only one CT machine in NBRHC and a limited amount of staff available in the department. If the CT machine is in use when a code stroke comes in, they would have to wait for the machine to become available, forming a bottle neck for the NBRHC. This not only affects the hospitals performance, but he efficiency of it as well.
Once the CT and lab results are in, they are assessed by a neurologist who will verify the stoke is ischemic, and then the tPA can then be administered. At NBRHC, if there is no neurologist on staff, ER physicians have to contact telehealth and request a consult with a neurologist via teleconference. This process is time consuming and inefficient. There is also a problem with not always having a neurologist available right away. By identifying the problems such as gaps and redundancies in the stroke protocol process, the team can assess and determine any possible improvements that can be created, even with the current cutbacks to NBRHC, the door-to-needle time for tPA administration can be decreased to Ontario

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