Background:
Timely access to brain imaging and reperfusion therapy is critical for optimal stroke outcomes. Regional hospitals face challenges in achieving benchmark Door to CT (DTCT) and Door to Needle (DTN) times due to workforce and system constraints. Bendigo Health, a regional service managing approximately 350 stroke transient ischaemic attack presentations annually, undertook a quality improvement initiative to streamline acute stroke pathways.
Methods:
Improvement science methodology using Plan–Do–Study–Act (PDSA) cycles was applied. Detailed process mapping followed the patient journey from ambulance arrival to CT imaging and thrombolysis. Interventions included ambulance pre‑notification of the stroke team, introduction of a readily accessible thrombolysis box with medications/protocols, relocation of the Stroke Coordinator desk closer to the Emergency Department, medical registrar resources to support Code Stroke leadership, implementation of a Direct to CT flow chart, and a Stroke Resource Response Nurse role. Stroke call simulations tested redesigned workflows and identified previously unrecognised gaps in CT access.
Results:
The primary aim was to reduce DTN time from 92 minutes to 80 minutes (15%). Following implementation of Direct to CT processes, DTN time reduced to 59 minutes in 2025, representing an approximate 30% improvement. DTCT times also improved, decreasing from 35 minutes in 2024 to 26.5 minutes in the first quarter of 2026. As a result of Direct to CT changes, DTN times reduced substantially, demonstrating the downstream impact of early imaging access.
Conclusion:
Direct to CT pathways supported by improvement science can deliver sustained improvements in acute stroke care in regional hospitals.