MORGANTOWN — Research from West Virginia University has shown that standardized protocols from the American Heart Association and American Stroke Association can significantly speed up stroke treatment times in hospitals. These guidelines are effective even for medical teams that quickly assemble from different departments.
Stroke treatment is a race against time. When a patient arrives at the emergency room, a coordinated team response involving EMS, neurologists, pharmacists, physicians, nurses, radiologists, and technicians is crucial. AHA and ASA guidelines provide specific time limits to optimize care from the onset of an ischemic stroke, where blood flow to the brain is blocked, to the delivery of treatment.
Associate professor Bernardo Quiroga, from WVU’s John Chambers College of Business and Economics, and his coauthors addressed whether these best practices improve performance. Their study, published in the Journal of Operations Management, analyzed data from over 8,000 patients treated for stroke at a large hospital from 2009 to 2017.
“‘Time is brain’ for stroke victims,” Quiroga explained. “Blocked blood flow to the brain kills almost two million neurons a minute, so your life or ability to walk or talk hinges on how quickly multiple professionals coordinate to restore blood flow.”
In 2010, the AHA and ASA launched Target: Stroke to standardize stroke care. Participating hospitals reduced median treatment times from 79 minutes in 2009 to 51 minutes in 2017. Researchers sought to determine if this improvement was due to adherence to best practices or simply gaining experience.
Their findings showed that more practice led to faster response times. Each doubling of cumulative stroke alerts decreased “door-to-needle time,” the time from hospital arrival to TPA infusion, by 10.2%.
Additionally, best practices were highly effective. Protocols such as the Helsinki Model, which streamlines patient transport to CT rooms, and the Rapid Administration of TPA protocol, which ensures medication is ready before scans are completed, further reduced treatment times.
Coauthor Brandon Lee emphasized the importance of hospital stroke advisory committees, which set performance targets, evaluated teams, and provided feedback. Without such measures, sustaining these best practices, especially for ad hoc teams, would be challenging.
Quiroga noted that “compliance is difficult because the hospital needs to coordinate with multiple independent EMS systems. Some EMS providers may be reluctant to commit resources to extended time in the CT room, and EMS staff turnover may lead to forgetting.”
Despite these challenges, the research found that ad hoc teams, although slower to learn, still improved over time. Neurologists’ recent experience treating stroke patients did not significantly affect the team’s response time, indicating the consistent quality of care provided by following best practices.
“The implication is that learning and sustaining best practices ensures an even quality of care for patients, regardless of individual neurologists’ experience levels,” said Quiroga.
