Nurse-driven service model reduces door-to-needle time by 16.72 minutes 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.