Introduction Swift intervention is critical in acute ischemic stroke (AIS) management. Ireland’s ‘Door to Decision in under 30!’ initiative aimed to expedite AIS assessment for thrombectomy, crucial for optimizing outcomes.

Aim of Study This study evaluates the five-year efficacy of the initiative on stroke treatment timelines.

Methods This longitudinal study spanned 22 Irish hospitals participating in an 8-month QI program, underpinned by the IHI Breakthrough Series Collaborative model. Multidisciplinary teams systematically mapped existing care processes, pinpointing key areas for enhancement. Utilizing Plan-Do-Study-Act (PDSA) cycles, targeted interventions were implemented, including pre-hospital alerts, patient pre-registration optimization, efficient staff paging and role allocation, immediate availability of decision-makers, administration of thrombolytic therapy in the CT room, and preparation of blood tests and imaging. The study meticulously tracked ‘Door to CT’, ‘Door to Needle’, and ‘Door to Decision’ times in AIS cases.

Results The period saw an increase in treated patients from 145 to 276. Concurrently, median Door to CT time significantly declined by 32.3% (from 31 to 21 minutes, p=0.02). Similarly, Door to Needle time decreased by 36.1% (from 61 to 39 minutes, p=0.006), Door to Mothership Contact by 38.5% (from 78 to 48 minutes, p=0.013), and Door to Decision by 37.8% (from 82 to 51 minutes, p=0.008). These improvements demonstrate the initiative’s substantial impact on stroke care.

Conclusion The initiative led to significant and lasting improvements in AIS treatment efficiency, substantiating the collaborative, structured QI approach’s role in clinical advancements.