Impact of Emergency Stroke Green Channel Implementation on Door-To-Needle Time and 90-Day Outcomes in Acute Ischemic Stroke Patients.

Abstract

Timely administration of intravenous thrombolysis is critical for favorable outcomes in acute ischemic stroke. This study evaluated the impact of implementing an emergency stroke green channel on door-to-needle time (DNT) and 90-day functional outcomes. This retrospective, single-center, pre-post quasi-experimental study included 139 consecutive acute ischemic stroke patients who received intravenous thrombolysis. We compared DNT, DNT ≤60-minute achievement rates, and 90-day modified Rankin Scale scores before (n = 70) and after (n = 69) green channel implementation. Multivariable regression models were used to adjust for potential confounders. The median DNT decreased significantly from 62.5 minutes pre-intervention to 35.0 minutes post-intervention (P < 0.001). The percentage of patients achieving DNT ≤60 minutes increased from 45.7% pre-intervention to 88.4% post-intervention. Good functional outcome (modified Rankin Scale = 0-2) improved from 59% overall at discharge to 80% overall at 90-day follow-up; in the post-intervention group, 90.7% achieved good outcomes at 90 days versus 70.0% pre-intervention (P = 0.005). In-hospital mortality was 1.4% overall, while 90-day mortality was 11.5% overall. After adjusting for baseline characteristics, green channel implementation remained independently associated with shortened DNT (40.2% reduction, P < 0.001) and improved 90-day functional outcomes (adjusted odds ratio = 3.84, 95% confidence interval: 1.42-10.41, P = 0.008). Implementation of an emergency stroke green channel significantly reduced DNT and was associated with improved 90-day functional outcomes in acute ischemic stroke patients receiving intravenous thrombolysis. These findings support the adoption of streamlined protocols to optimize hyperacute stroke care.