Background
Lakeridge Health Oshawa is a District Stroke Centre that provides hyper-acute stroke care for the Durham Region.  For three fiscal years the annual Door-To-Needle (DTN) times exceeded 65 minutes. The District Stroke Centre was forced to take a fresh look at the process.
Method
An environmental scan was conducted in an attempt to identify delays in treatment.  This was followed by a literature review and poll of Stroke Centres across Ontario  to examine what had been successfully implemented in other organizations. A working group was formed with representatives from all internal and external partners. Representatives shared drafts and solicited feedback from staff in their areas. Following several revisions a live simulation was conducted. A debrief followed and the final algorithm was completed on November 28, 2017. ED staff was engaged in the month preceding and following the go live date to review the new protocol and to provide feedback. The protocol went live on December 4, 2017. The CNS attended code strokes to offer support and education. 
Results
The recreated protocol included an overhead Stroke Alert prior to patient arrival, assessment of patient and transfer to CT on EMS stretcher, and delivery of tPA on the CT table. These changes have significantly decreased the DTN times. Three months following implementation DTN times have reduced by 30 minutes and continue to trend downward. The six-month data will be presented at Congress.
 
Conclusions
Significant improvements have occurred through thoughtful implementation strategies and staff commitment to improve patient outcome.

RESETTING THE DTN CLOCK: A COMMUNITY HOSPITAL EXPERIENCE