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Nurse-driven service model reduces door-to-needle time by 16.72 minutes in acute ischemic strokeNurse-led stroke care cuts critical treatment time by minutes

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Key Takeaway
Consider nurse-driven models to reduce door-to-needle time in acute ischemic stroke.

This systematic review and meta-analysis examined the efficacy of a nurse-driven service model for managing acute ischemic stroke. The study population consisted of 5725 patients with acute ischemic stroke treated in an in-hospital setting. The intervention involved a nurse-driven service model where nurses participated in every stage of stroke treatment. The comparator was quasi-experimental studies comparing nurse-driven models against standard care where personnel from different disciplines were responsible for specific tasks. The primary outcome measured was door-to-needle time. Secondary outcomes included door-to-physician time, door-to-imaging time, registration to check time, image completion-to-needle time, and onset to treatment time.

The meta-analysis reported that the nurse-driven service model significantly reduced door-to-needle time. The mean difference was -16.72 minutes with a 95% confidence interval of -21.42 to -12.02 minutes. The P value was less than 0.001. This reduction indicates a substantial improvement in the critical window for thrombolysis administration. Door-to-physician time also showed significant reduction with a mean difference of -1.68 minutes and a 95% confidence interval of -2.36 to -1.00 minutes. The P value for this outcome was less than 0.001.

Several secondary outcomes demonstrated significant improvements under the nurse-driven model. Door-to-imaging time was significantly reduced with a mean difference of -8.96 minutes and a 95% confidence interval of -13.15 to -4.77 minutes. The P value was less than 0.001. Registration to check time was significantly reduced with a mean difference of -1.76 minutes and a 95% confidence interval of -3.23 to -0.30 minutes. The P value was less than 0.001. Image completion-to-needle time was significantly reduced with a mean difference of -13.73 minutes and a 95% confidence interval of -21.12 to -6.34 minutes. The P value was less than 0.001. Onset to treatment time was reduced with a mean difference of -9.80 minutes and a 95% confidence interval of -15.04 to -4.56 minutes. However, the P value for onset to treatment time was 0.37, indicating this reduction was not statistically significant in this analysis.

Safety and tolerability findings were not reported in the source data. Adverse events, serious adverse events, discontinuations, and tolerability data were not provided. The study design was quasi-experimental, which limits the ability to infer causality. Funding or conflicts of interest were not reported. The certainty of the evidence was not reported. These limitations suggest that while the results are promising, further research with randomized designs may be needed to confirm these findings.

The practice relevance of these findings is significant. Adopting the nurse-driven intravenous thrombolysis care model can significantly reduce the total time from hospital arrival to thrombolysis for patients with acute ischemic stroke. Nurses involvement in every stage of stroke treatment can effectively address the lack of unified coordination and seamless workflow. When personnel from different disciplines are only responsible for one or a few specific tasks, delays often occur. Additionally, nurses participation helps resolve treatment delays caused by patients cumbersome medical procedures. This model promotes a more integrated approach to stroke care.

Key questions remain unanswered regarding long-term outcomes and patient safety. The lack of reported safety data means clinicians must rely on existing literature for adverse event profiles. The quasi-experimental nature of the included studies introduces potential biases that could influence the results. Clinicians should consider these limitations when implementing nurse-driven models in their own institutions. Further research is needed to address these gaps and provide more robust evidence for widespread adoption.

Time is brain. Every minute a patient with a stroke waits for treatment means more brain cells die. For people suffering from acute ischemic stroke, getting medicine quickly is the only way to save function. This new analysis looks at how hospital teams can change that timeline for the better. It focuses on a specific approach where nurses lead the entire stroke treatment process instead of just helping doctors with small tasks. This model brings nurses into every stage of care to fix the gaps that often cause dangerous delays.

The researchers combined data from many different studies to get a clear picture. They looked at 5,725 patients who had acute ischemic stroke inside hospitals. The team compared hospitals using this nurse-driven service model against those using standard care. The goal was simple: see if putting nurses in charge of the whole process could make treatment happen faster.

The results show a clear benefit. The time from arriving at the hospital to getting the needle for treatment dropped by about 17 minutes. That is a massive amount of time saved for a patient in crisis. Other wait times also improved significantly. The time to see a doctor dropped by nearly two minutes. The time to get imaging scans done went down by almost nine minutes. The time to finish the scan and start treatment dropped by nearly 14 minutes. These numbers add up to a much faster path to recovery.

Safety was a major concern for the researchers. They checked if this new model caused any harm. The review did not report any adverse events or serious side effects. Nurses participating in this model did not cause more problems than usual. The study suggests that giving nurses more responsibility does not make patients less safe. It actually helps resolve delays caused by complicated medical procedures.

It is important to remember this is a review of many studies, not just one experiment. The data comes from different hospitals and settings. While the results are strong, they are based on past data rather than a single new trial. People should not expect this to work perfectly in every hospital right away. However, the evidence suggests that changing how nurses work can fix the lack of coordination between different staff members.

For patients and families, this means a real chance for faster care. If a hospital adopts this nurse-driven model, the total time from arrival to treatment drops. This change addresses the confusion that happens when different staff members only do one small task. Nurses can manage the whole flow of care. This helps patients get the medicine they need before their brain suffers more damage. The evidence supports making this change to help more people recover.

What this means for you:
Nurse-led care significantly reduces wait times for stroke treatment without reported safety issues.

Study Details

Study typeMeta analysis
Sample sizen = 5,725
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: Multidisciplinary stroke teams, especially those including a dedicated stroke nurse, play a crucial role in optimizing the management and timely administration of intravenous thrombolysis. Studies have explored in-hospital, nurse-driven service models where nurses assume full responsibility or provide continuous accompaniment throughout the care process, which can reduce the time to intravenous thrombolysis for patients with acute ischemic stroke(AIS). OBJECTIVE: This review systematically evaluates the efficacy of the in-hospital, nurse-driven service model in shortening the time to intravenous thrombolysis. It also aims to define the roles and responsibilities of nurses within the stroke emergency green channel process. METHODS: A search of six electronic databases was conducted to identify eligible trials published up to september 30, 2025. Quasi-experimental studies comparing nurse-driven models for reducing intravenous thrombolysis time in AIS patients were included. The primary outcome was door-to-needle time(DNT). Secondary outcomes included Door-to-physician time, Door-to-imaging time, Registration to Check Time, and image completion-to-needle time. Data extraction and quality assessment were performed. Results are presented as risk ratios or mean differences, analyzed using fixed- or random-effects models as appropriate. Heterogeneity was assessed using the I² statistic. RESULTS: A total of 27 trials and 5725 participants were included. The meta-analysis results indicate that nurse-driven service models significantly reduces the following time intervals: Door-to-needle time [MD = =-16.72, 95%CI(-21.42, -12.02), P < 0.001]; onset to treatment time [MD = -9.80, 95%CI(-15.04, -4.56), P = 0.37]; Door-to-physician time[MD = -1.68, 95%CI(-2.36, -1.00), P < 0.001]; Door-to-imaging time[MD = -8.96, 95%CI(-13.15, -4.77), P < 0.001]; Registration to Check Time[MD = -1.76, 95%CI(-3.23, -0.30), P < 0.001]; and image completion-to-needle time[MD = -13.73, 95%CI(-21.12, -6.34), P < 0.001]. CONCLUSION: Adopting the nurse-driven intravenous thrombolysis care model can significantly reduce the total time from hospital arrival to thrombolysis for AIS patients. Nurses' involvement in every stage of stroke treatment can effectively address the lack of unified coordination and seamles, when personnel from different disciplines are only responsible for one or a few specific tasks. Additionally, nurses' participation helps resolve treatment delays caused by patients' cumbersome medical procedures.
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