The Smart Stroke Fast Track: A Digital Workflow Innovation to Reduce Door-to-Needle Time in Acute Ischemic Stroke

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INTRODUCTION: Timely thrombolysis is crucial for acute ischemic stroke (AIS) treatment, but delays often persist due to fragmented communication and inefficient workflows. The Smart Stroke Fast Track (SSFT) is a digital workflow platform developed to digitize and streamline acute stroke care. This study evaluates the SSFT's impact on reducing door-to-needle (DTN) time and enhancing workflow efficiency in AIS management. METHODS: A pre-post implementation study was conducted at Naresuan University Hospital. The SSFT platform is an in-hospital application accessible via mobile, tablet, and desktop, which integrates triage, one-click team alerts, automated recombinant tissue plasminogen activator dose calculation, patient tracking, and a digital checklist. Data from AIS patients treated pre- and post-SSFT implementation were compared. The primary outcome was median DTN time. The secondary outcomes included the proportion of patients treated within 60 and 45 min, symptomatic intracerebral hemorrhage (sICH) rate, in-hospital mortality, neurological/functional outcomes, and key workflow time intervals (door-to-physician, door-to-stroke team, door-to-CT, and door-to-laboratory result times). RESULTS: Forty patients were included (pre: 20; post: 20). Median DTN time significantly decreased from 57.5 min (IQR 45-68) to 41.5 min (IQR 36.5-52) (p < 0.001). Treatment within 60 min increased from 60% to 100% (p = 0.002) and within 45 min from 25% to 55% (p = 0.053). Significant reductions were observed in key workflow time intervals (all p < 0.05). No significant differences were observed in sICH, in-hospital mortality, or neurological/functional outcomes. CONCLUSION: The SSFT platform effectively reduced AIS treatment delays and improved workflow coordination. This digital innovation offers a scalable solution for improving stroke systems in resource-limited settings.

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