The 73-year-old man arrives in casualty at 9:48 p.m. with right-sided weakness and mild dysarthria. The family says he was fine at 8:15 p.m. when they left for dinner. They found him at 9:30 sitting in the chair, unable to lift his right arm.

Last-known-well: 8:15 p.m. Current time: 9:48 p.m. The window is 93 minutes from onset. The 4.5-hour thrombolysis window is wide open. CT is available. The medicine team is on the floor.

The patient is registered, triaged. The resident orders a CT. The CT is done at 10:32 p.m. The radiologist reads it at 10:51 p.m. — no haemorrhage. The resident calls neurology at 11:04 p.m. Neurology arrives at 11:32 p.m. The clinical exam is repeated. Thrombolysis is given at 12:08 a.m.

Total: 140 minutes from arrival to needle. The door-to-needle target is 60 minutes (AHA/ASA, multiple updates). The published Indian DTN times average 60–90 minutes in stroke centres with established pathways, and 120+ minutes in centres without (Pandian et al., Int J Stroke, 2017).

The difference between a 60-minute DTN and a 140-minute one is, for the average ischaemic stroke patient, roughly two million neurons. Time is brain. The published number is approximately 1.9 million neurons lost per minute in a typical large-vessel occlusion (Saver, Stroke, 2006).

Where the time went, in the case above:

12 minutes in registration / triage queue
44 minutes waiting for CT (single scanner, three competing requests)
19 minutes for radiology read
13 minutes for neurology to arrive
36 minutes for neurology decision and thrombolysis prep

No single step was bad medicine. Every step was reasonable. The cumulative effect was bad.

A workspace cannot fix the CT queue. It can shorten the radiology read by attaching the CT to the patient card the moment it's done. It can flag "last known well" prominently so every clinician seeing the patient knows where the window stands. It can pre-stage the thrombolysis order so the consultant arrives to a pre-filled order pending sign-off.

Small things. Each shaves three minutes. Three minutes is six hundred thousand neurons.