A Network-Wide Stroke Team Program Reduces Time to Treatment for Endovascular Stroke Therapy in a Regional Stroke-Network

Cerebrovasc Dis. 2018;45(3-4):141-148. doi: 10.1159/000487965. Epub 2018 Mar 27.


Background and purpose: Driven by the positive results of randomized, controlled trials of endovascular stroke therapies (EVT) in stroke patients with large vessel occlusion, different approaches to speed up the workflow for EVT candidates are currently being implemented worldwide. We aimed to assess the effect of a simple stroke network-wide workflow improvement project, primarily focusing on i.v. thrombolysis, on process times for patients undergoing EVT.

Methods: In 2015, we conducted a network-wide, peer-to-peer acute stroke workflow improvement program for i.v. thrombolysis with the main components of implementing a binding team-based algorithm at every stroke unit of the regional network, educating all stroke teams about non-technical skills and providing a stroke-specific simulation training. Before and after the intervention we recorded periprocedural process times, including patients undergoing EVT at the 3 EVT-capable centers (January - June 2015, n = 80 vs. July 2015 - June 2016, n = 184).

Results: In this multi-centric evaluation of 268 patients receiving EVT, we observed a relevant shortening of the median time from symptom onset to EVT specifically in patients requiring secondary transfer by almost an hour (300 min, 25-75% interquartile range [IQR] 231-381 min to 254 min, IQR 215.25-341 min; p = 0.117), including a reduction of the median door-to-groin time at the EVT-capable center in this patient group by 15.5 min (59 min, IQR 35-102 min to 43.5 min, IQR 27.75-81.25 min; p = 0.063). In patients directly admitted to an EVT-capable center, the median door-to-groin interval was reduced by 10.5 min (125 min, IQR 83.5-170.5 min to 114.5 min, IQR 66.5-151 min; p = 0.167), but a considerable heterogeneity between the centers was observed (p < 0.001).

Conclusions: We show that a simple network-wide workflow improvement program primarily directed at fast i.v. thrombolysis also accelerates process times for EVT candidates and is a promising measure to improve the performance of an entire stroke network.

Keywords: Crew resource management; Endovascular stroke therapy; Non-technical skills; Simulation; Stroke; Thrombolysis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Pathways / organization & administration
  • Delivery of Health Care, Integrated / organization & administration*
  • Efficiency, Organizational*
  • Endovascular Procedures*
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Germany
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Patient Care Team / organization & administration*
  • Patient Transfer / organization & administration
  • Program Evaluation
  • Quality Improvement / organization & administration
  • Quality Indicators, Health Care / organization & administration
  • Regional Health Planning / organization & administration*
  • Retrospective Studies
  • Stroke / diagnostic imaging
  • Stroke / physiopathology
  • Stroke / therapy*
  • Thrombolytic Therapy*
  • Time Factors
  • Time-to-Treatment / organization & administration*
  • Workflow


  • Fibrinolytic Agents