Effect of emergency department triage model on door-to-needle time in patients with acute ischemic stroke: a retrospective study

Objective This retrospective study aims to investigate the impact of the emergency department triage model on door-to-needle (DTN) time in patients with acute ischemic stroke (AIS). Methods 641 patients with AIS who used the emergency medical system (EMS) and visited the emergency department (ED) via the green passage from January 2021 to December 2022 were collected. They were then divided into a triage group (n = 297) and a stroke team group (n = 344) based on whether they were seen directly by the stroke team or triaged first in the hospital. Comparing demographic data, vital signs, blood glucose, comorbidities, Field Assessment Stroke Triage for Emergency Destination Score (FAST-ED), NIHSS score, and time spent in each phase of the prehospital process and in-hospital process in both groups, including emergency response time, on-scene time, transport time and the time spent from admission to completion of each emergency procedure. In patients who received thrombolytic therapy, the time from admission to completion of informed consent and the total time from admission to intravenous thrombolysis (IVT) were further compared between the two groups. Results 641 patients with AIS were included, with a mean age of 71.36 years and 62.1% were male. On-scene time accounted for the largest proportion of total pre-hospital time, 37.2–40.5%, 17min and 16min, respectively, without significant difference between the two groups. In-hospital triage time was significantly shorter in the stroke team group than in the triage group (0min vs 4min, P < 0.001) and the time from admission to completion of the NIHSS score was shorter, but no statistically significant difference was seen (15min vs 18min, P = 0.062). The stroke team group took significantly less time to obtain an informed consent (34min vs 36min, P = 0.040). In addition, the median DTN time was significantly shorter in the stroke team group (37min) compared to the triage group (48min, P = 0.037). Conclusion Reducing the in-hospital triage process for patients with AIS using the EMS is essential to reduce DTN time.