Root Cause Exploration of DNT Delay in Patients with Acute Ischemic Stroke: A Mixed-Method Study Based on the Experience of Front-Line Nurses in Stroke Green Channel

DOI: https://doi.org/10.62517/jmhs.202605403

Author(s)

Chen Ya

Affiliation(s)

Pengshui Miao and Tujia Autonomous County People's Hospital, Chongqing, China

Abstract

Anchored in the perspective of sociotechnical system theory, this study combines quantitative time data with the qualitative experience of front-line nurses to analyze the core nodes, multi-level root causes and coupling mechanism of door-to-needle time (DNT) delay in patients with acute ischemic stroke (AIS), so as to provide theoretical basis and practical paths for the systematic optimization of stroke green channel. An explanatory sequential mixed-method study design was adopted. The first phase was a retrospective quantitative study, which enrolled 156 AIS patients who received intravenous thrombolysis in a tertiary grade A hospital from January 2022 to June 2023, and identified the core delay links through time disassembly and descriptive statistics. The second phase was a qualitative study, in which 14 front-line nurses working in the stroke green channel were interviewed with semi-structured in-depth interviews focusing on the core delay links. Colaizzi phenomenological analysis method was used for coding and theme extraction to construct an explanatory model of delay mechanism. The results showed that the median DNT was 58 min, among which imaging examination, informed consent and waiting for test results accounted for the highest proportion of time, 24.1%, 20.7% and 18.3% respectively, which were the core key nodes of DNT delay. The qualitative study extracted four levels of root causes: structural layer, process layer, subject layer and cultural layer. Its mechanism is manifested as follows: structural resource allocation defects lay the basic boundary of delay, cross-departmental process breakpoints form the transmission path of delay, differences in subject competence and decision-making amplify the degree of delay, and implicit culture and institutional environment shape the behavioral logic of delay from the deep level. The four levels eventually form system-level efficiency loss through the mismatched coupling between technical subsystem and social subsystem. DNT delay is not an efficiency problem of a single link, but the result of multi-level coupling failure of "structure-process-subject-culture" in the stroke treatment sociotechnical system. To shorten DNT, we cannot only rely on single-point speed improvement, but must promote the collaborative optimization of both technical and social dimensions from the perspective of system reconstruction.

Keywords

Acute Ischemic Stroke; Door-to-Needle Time; Stroke Green Channel; Front-Line Nurses; Mixed-Method Study; Coupling Mechanism; Sociotechnical System

References

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