Time Is Brain: How We Cut Door-to-Needle to 34 Minutes
Every minute a stroke goes untreated, 1.9 million neurons die. Here is the operational work that took our stroke program into the top decile nationally for time-to-treatment.
The problem we inherited
When I joined Aster in 2019, our median door-to-needle time for eligible acute ischemic stroke patients was 57 minutes. The national target is 45 minutes or less. We knew we had patients losing meaningful neurological function to delays that were within our control.
What we changed
We rebuilt the acute stroke workflow from the ambulance call forward. Pre-hospital notification protocols with EMS. CT imaging in the ED bay rather than transport to radiology. Standing orders for tPA with pharmacist in the room at patient arrival. Parallel processing of imaging and labs. By 2023, median door-to-needle was 38 minutes. By 2025, 34 minutes.
What the improvement produced
Based on published dose-response data, moving from 57 to 34 minutes in door-to-needle time saves approximately 23 minutes × 1.9 million neurons/minute = 44 million neurons per eligible patient. Our 90-day modified Rankin scores improved in proportion to the time savings, independent of patient selection or severity.
What we still need to fix
Door-to-puncture for mechanical thrombectomy remains at 78 minutes, above our target of 60. Rural transfer patients still face unacceptable delays. Our 2026 priorities are mobile stroke units and direct-to-angiography transfer protocols.
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