Development of a Stroke Fast Track Service Model to Reduce Door-to-Needle Time for Intravenous Thrombolysis in Patients with Acute Ischemic Stroke at Kranuan Crown Prince Hospital.
Keywords:
acute ischemic stroke, stroke fast-track service, KRANUAN 7R, participatory action research, Door-to-Needle TimeAbstract
This study aimed to examine the existing situation, develop a stroke fast-track service model appropriate to the context of Kranuan Crown Prince Hospital, and evaluate its effectiveness. This participatory action research was conducted in two cycles from October 2024 to September 2025. Participants included 22 multidisciplinary healthcare professionals and 70 patients with acute ischemic stroke who received intravenous thrombolysis. The patients were divided into a pre-implementation group of 31 patients and a post-implementation group of 39 patients. The research instruments comprised a semi-structured interview guide, patient data record forms, meeting and reflection records, and a service model evaluation form. The content validity of the instruments was examined by five experts, with an item-objective congruence index of 1.00 for all items. Quantitative data were analyzed using descriptive statistics, the Mann–Whitney U test, and Fisher’s exact test. Qualitative data were analyzed using content analysis.
Results: The developed KRANUAN 7R Stroke Fast Track Model consisted of seven components: Recognize, Relay, Route, Run Parallel, Regulate, Reperfusion, and Recover. These components covered screening and early activation, rapid transportation, parallel workflow, multidisciplinary coordination, intravenous thrombolysis, and continuity of care. The model was supported by clinical practice guidelines, clinical nursing practice guidelines, a clinical pathway, Fast Lab and Fast Pharmacy systems, QR codes, and educational videos. Following implementation, the mean door-to-CT time significantly decreased from 18.23 ± 8.30 to 13.31 ± 8.27 minutes (p<.001). The mean door-to-needle time significantly decreased from 51.71 ± 13.94 to 44.62 ± 13.37 minutes (p=.005). Furthermore, the proportion of patients receiving intravenous thrombolysis within 45 minutes significantly increased from 38.71% to 69.23% (p=.015).
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