Background
National stroke registries enable benchmarking of reperfusion rates and treatment times, supporting continuous quality improvement. The New Zealand National Stroke Register was established in 2015, with Waikato Hospital contributing data since 2019. Increasing demand for acute assessment and reperfusion therapies has required ongoing optimisation of stroke pathways.
Aims
To evaluate trends in workload, reperfusion therapy, and treatment times at Waikato Hospital from 2022–2025, and to describe service improvements implemented during this period.
Results
Data were obtained from the hospital code stroke log and the National Stroke Register.
Average monthly code stroke activations increased from 66 in 2022 to 79 in 2025.
Reperfused cases (thrombolysis and/or thrombectomy) increased from 60 in 2022 to 109 in 2025. The number of patients receiving thrombolysis rose from 43 in 2022 to 88 in 2025.
Median door-to-CT time decreased from 25 minutes in 2022 to 21 minutes in 2025. Median door-to-needle time improved from 63 minutes in 2022 (71 minutes in 2023) to 53.5 minutes in 2025.
Service developments included the addition of a stroke physician in March 2023, attending Code Stroke calls 1.5 days per week. Initiatives since include: regular RMO and nurse education and simulation training, and radiology workflow redesign enabling on-table thrombolysis and direct progression to advance imaging. A monthly governance meeting supported review of reperfused cases and outcomes.
Conclusion
Despite rising workload, treatment times improved. An additional stroke physician, combined with multidisciplinary education, pathway redesign, and regular performance review, was associated with improvements in the delivery of acute stroke care.