Background and Aims:
Describe the strategies implemented in our stroke center to reduce reperfusion times in acute stroke.
Methods:
Prospective registry of reperfusion time metrics [door-to-needle (DtN) and Door-to-groin (DtG) times] from 2011 to 2018.
Results:
In this period we have treated 986 patients with rtPA and 948 with endovascular therapies. rtPA Group characteristics: Mean age 75 +/-14y.o, 49.5% Men, baseline NIHSS 8[5-13]. Endovascular group: 72+/-13, 54% Men, baseline NIHSS 16[11-20]. Our initial DtN time was 44min, DtG 80min.
In 2012, we implemented a video-monitoring system to identify delays in the beginning of rtPA, to guide and teach the personnel involved in emergencies. This measure helped to detect delaying situations and potentially avoidable before rtPA bolus (as written informed consent, blood test, electrocardiogram, chest x-ray, transcranial Doppler). We achieved a DtN of 39min.
In 2015, we implemented the direct transfer of patients from the ambulance to the CT (Code-CT) with immediate interpretation of the neuroimaging by a trained stroke neurologist and rtPA bolus in the CT by a mobile nurse of the Stroke Unit. It has drastically reduced our median DtN time to 36min without compromising safety. In 2016 we also implemented the direct transfer of patients from the ambulance to the angiosuite (Code-Angio), achieving a DtG of 48min.
Our current DtN is 27min and DtG 46min. Even our reperfusion rate is increasing year after year, those strategies together with the experience and involvement of professionals, have shown a significant reduction of our DtN 28,3% and DtG 56,6%. 

Conclusions:
Strategies implemented at our stroke center have shown a progressive and significant reduction of reperfusion time metrics.

STRATEGIES FOR SHORTENING REPERFUSION TIME METRICS