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A case study on the treatment of stroke patients in Norway

Reducing ‘door-to-needle’ time for acute brain stroke patients in Norway

Haraldsplass Deaconess Hospital (HDS) is a university hospital in Bergen, Norway. It is the second largest hospital in Bergen and treats approximately 14,500 inpatients and 15,800 outpatients annually.


In Norway, around 15,000 people a year suffer from stroke – a condition that occurs when the blood supply to the brain is interrupted or reduced.

Stroke is one of the major causes of death and disability, and poses a huge challenge for those affected and their relatives, for medical services and society as a whole. Patients with symptoms of acute brain stroke need immediate hospitalization and treatment. Rapid and correct treatment can reduce some of the most severe consequences of brain stroke. For a patient with an acute or ‘ischemic’ stroke, every minute that passes without treatment results in a poorer outcome and more damage. 

An analysis showed that Haraldsplass Deaconess Hospital, located in the city of Bergen in Norway, was taking 70 minutes on average to deliver thrombolysis therapy to patients suffering from ischemic strokes – far exceeding the target of 30 minutes set by the Western Norway Regional Health Authority. The reason for this was that the initiation of thrombolytic therapy often did not happen until after the patient was taken through a series of different diagnostic processes and transported to the intensive care unit.

What did we do?

To provide the best possible clinical pathway for these patients, the hospital set up a project to identify actions to reduce the “door-to-needle” time. PwC was asked to manage the project, supported by an interdisciplinary team from the hospital, assembled from units involved in diagnosis and treatment.

The project team began by mapping out the existing pathway, enabling the team to identify bottlenecks. This included physical ‘door-to-needle’ simulations including PwC team members acting as patients and ambulance drivers, to really understand where and why time was being lost, leading to critical delays.

Using the results, the team were able to develop and propose a new clinical pathway providing faster diagnosis, more efficient patient treatment and better outcomes for the patient. This new approach was approved by the hospital, who then gave the go-ahead for it to be implemented.

What impact did we make?

With the new pathway in place, the average medical delivery time was reduced dramatically from approximately 70 minutes to 16-20 minutes.

There is also a continued and increased focus on ‘door-to-needle’ clinical pathway performance, with regular simulations, training and usage of key performance indicators (KPIs) to support continuous improvement.

Contact us

Ron Chopoorian

Ron Chopoorian

Global Health Industries Leader, Partner, PwC United States

Sarah Butler

Sarah Butler

Global Health Services Leader, Partner, PwC Australia