Abstract TP320: Different Response Times to Intrahospital Stroke Between Medical and Surgical Infirmaries: A Dunning-Kruger Effect?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Iago N Perissinotti ◽  
Fernanda A Salvadori ◽  
Barbara S Fonseca ◽  
Marcelo Calderaro
Keyword(s):  
Statistical Power ◽  
Response Times ◽  
Intravenous Thrombolysis ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Tertiary Hospital ◽  
Surgical Teams ◽  
Medical Wards ◽  
Different Response

Rapid response teams (RRT) improve speed and quality of urgent inpatient care. Nonetheless, its effectiveness depends on adequate problem identification and fast triggering of institutional procedures. Differences in patient profiles and team experience between medical (Me) or surgical (Su) wards may influence the response times to suspected intrahospital strokes. From January/2016 through April/2019, we retrospectively analyzed data in a large tertiary hospital in Brazil. There were proportionally more callings for suspected strokes in medical wards (36/281 [13%] Me vs. 16/619 [2%] Su, p<0.001) in relation to the total of calls for any reason, while the ratio of diagnostic confirmation was similar (19/36 [52%] Me vs. 10/16 [62%] Su, p=0.495). Ischemic strokes were more prevalent in both infirmaries (17/19 [89%] Me vs. 8/10 [80%] Su, p=0.43). While not statistically significant, there were numerical differences between time to symptom recognition and the interval between recognition and triggering of the RRT. Medical ward teams recognized symptoms on average 108 minutes after the presumed onset versus 164 minutes in surgical wards. Paradoxically, surgical teams more promptly called RRT after recognition, on average 93 versus 172 minutes. There were no statistical differences in the ratio of ischemic strokes submitted to intravenous thrombolysis (11/17 [35,3%] Me vs. 1/8 [12,5%] Su, p=0.25) or mechanical thrombectomy (2/17 [11,8%] Me vs. 0/8 Su, p=0.45), however it is possible that the small number of events (52 calls in 40 months) led to low statistical power. This study suggests there may be differences in initial responses to suspected intrahospital strokes between different ward profiles. These might be secondary to variations in patient characteristics and team education, but also be caused by a Dunning-Kruger phenomenon (i.e. a higher perception of knowledge on stroke care leading to delays in triggering institutional workflows). Identifying these divergences in further larger, prospective trials can help develop individualized interventions to improve the quality of care in these medical emergencies.

scholarly journals The Dutch Acute Stroke Audit: Benchmarking acute stroke care in the Netherlands

2018 ◽  
Vol 3 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Laurien S Kuhrij ◽  
Michel WJM Wouters ◽  
Renske M van den Berg-Vos ◽  
Frank-Erik de Leeuw ◽  
Paul J Nederkoorn
Keyword(s):  
Acute Stroke ◽  
Best Practice ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Favourable Outcome ◽  
Hospital Level ◽  
Acute Stroke Care ◽  
Related Factors ◽  
Variation In Care

Introduction In the nationwide Dutch Acute Stroke Audit (DASA), consecutive patients with acute ischaemic stroke (AIS) and intracranial haemorrhage (ICH) are prospectively registered. Acute stroke care is a rapidly evolving field in which intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT) play a crucial role in increasing odds of favourable outcome. The DASA can be used to assess the variation in care between hospitals and develop ‘best practice’ in acute stroke care. Patients and methods: We describe the initiation and design of the DASA as well as the results from 2015 and 2016. Results In 2015 and 2016, 55,854 patients with AIS and 7727 patients with ICH were registered in the DASA. Treatment with IVT was administered to 10,637 patients (with an increase of 1.3% in 2016) and 1740 patients underwent IAT (with an increase of 1% in 2016). Median door-to-needle time for IVT and median door-to-groin time for IAT have decreased from 27 to 25 min and 66 to 64 min, respectively. Mortality during admission was 4.9% in patients with AIS, whereas 26% of patients with ICH died. Modified Rankin Scale score at three months was registered in 49% of AIS patients and 45% of ICH patients. Discussion During the nationwide DASA, time to treatment is reduced for IVT as well as IAT. With the rapidly evolving treatment of acute stroke care, the DASA can be used to monitor the quality provided on patient- and hospital level. Conclusion Increasing completeness of registration of the outcome, in combination with adjustment for patient-related factors, is necessary to define and further improve the quality of the acute stroke care.

scholarly journals Changes in Stroke Patients’ Health-Seeking Behavior by COVID-19 Epidemic Regions: Data from the Korean Stroke Registry

2021 ◽  
pp. 1-9
Author(s):  
Han-Yeong Jeong ◽  
Eung-Joon Lee ◽  
Min Kyoung Kang ◽  
Ki-Woong Nam ◽  
Jeonghoon Bae ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Health Seeking ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Care Services ◽  
Health Seeking Behaviors ◽  
Number Of Patients ◽  
Using Data

<b><i>Introduction:</i></b> The coronavirus disease 2019 (COVID-19) pandemic has led to changes in stroke patients’ healthcare use. This study evaluated changes in Korean stroke patients’ health-seeking behaviors and stroke care services using data from the Korean Stroke Registry (KSR). <b><i>Methods:</i></b> We reviewed data from patients with acute stroke and transient ischemic attack (TIA) during 2019 (before COVID-19 period) and 2020 (COVID-19 period). Outcomes included patient characteristics, time from stroke onset to hospital arrival, and in-hospital stroke pathways. Subgroup analyses were performed for an epidemic region (Daegu city and Gyeongsangbuk-do region, the D-G region). <b><i>Results:</i></b> The study included 1,792 patients from the pre-COVID-19 period and 1,555 patients from the COVID-19 period who visited hospitals that contribute to the KSR. During the COVID-19 period, the D-G region had two-thirds the number of cases (vs. the pre-CO­VID-19 period) and a significant decrease in the proportion of patients with TIA (9.97%–2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 min vs. 526.5 min, <i>p</i> = 0.016), and longer onset-to-door times were common for patients with mild symptoms and who were in their 60s or 70s. The number of patients who underwent intravenous thrombolysis also decreased during the COVID-19 period, although the treatment times were not significantly different between the 2 periods. <b><i>Discussion/Conclusion:</i></b> Korean stroke patients in a CO­VID-19 epidemic region exhibited distinct changes in health-seeking behaviors. Appropriate triage system and public education regarding the importance of early treatment are needed during the COVID-19 pandemic.

Abstract 122: Quality of Care for Patients With Acute Ischemic Stroke as a Function of Hospital Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator Capability: Insights From China National Stroke Registry II

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Zhenzhen Rao ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yilong Wang ◽  
Yongjun Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Care Quality ◽  
Composite Score ◽  
Stroke Patients ◽  
Stroke Registry

Background: Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator (rt-PA) availability at Chinese hospitals varies and may affect care quality for acute ischemic stroke patients. Limited research has shown whether there were differences in quality of care at China National Stroke Registry (CNSR II) hospitals based on rt-PA capability. Methods: For acute ischemic stroke patients admitted to CNSR II hospitals between 2012 and 2013, care quality at hospitals with or without Intravenous rt-PA capability was examined by evaluating conformity with performance and quality measures. The primary outcome was guideline-concordant care, defined as compliance with 10 predefined individual guideline-recommended performance metrics and composite score. A composite score was defined as the total number of interventions actually performed among eligible patients divided by the total number of recommended interventions among eligible patients. Propensity score matching was used to balance the baseline characteristics. We used cox model with shared frailty model and logistic regression with generalized estimating equation to compare the relationship between hospitals with rt-PA capability and hospitals without rt-PA on quality measures. Results: This study included 19604 acute ischemic stroke patients admitted to 219 CNSR II hospitals. Before matching, there were 7928 patients admitted to 86 (40.4%) hospitals with rt-PA capability and 11676 patients admitted to 133 (59.6%) hospitals without rt-PA capability. After matching, 7606 pairs of patients in rt-PA-capable hospitals and rt-PA-incapable hospitals were analyzed. Before matching, the composite score of guideline-concordant process of care was higher at hospitals with rt-PA capability than hospitals without rt-PA capability (74% versus 73%, P=0.0126). Hospitals with rt-PA capability were more likely to perform deep vein thrombosis prophylaxis within 48 hours of admission, dysphagia screening, assessment or receiving of rehabilitation, discharge antithrombotic, anticoagulation for atrial fibrillation and medications for lowering low-density lipoprotein (LDL) ≥100mg/dL. But hospitals with rt-PA capability were less likely to perform antithrombotic medication within 48 hours of admission and hypoglycemic therapy at discharge for patients with diabetes. After matching, differences of stroke care quality between hospitals with rt-PA capability and without rt-PA capability still exist after adjusting covariates. Conclusions: The CNSR II hospitals were associated with better performance in some of the hospitals but not all of them. The difference in conformity between rt-PA-capable hospitals and rt-PA-incapable hospitals was modest for performance measures of stroke care. However, more room for improvement still exists in key quality performance measures and further studies should be explored.

Abstract T P37: Routine CT Angiography in Acute Stroke Does Not Delay Acute Stroke Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Gisele S Silva ◽  
Renata C Miranda ◽  
Rodrigo M Massaud ◽  
Andreia M Vacari ◽  
Miguel Cendoroglo Neto
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Tertiary Hospital ◽  
Acute Stroke Care ◽  
Time Intervals ◽  
Radiology Report ◽  
Group 2

Introduction: Vascular imaging is increasingly used for diagnosis of arterial occlusions in acute ischemic stroke. Hypothesis:We hypothesized that time intervals using a CTA based acute ischemic stroke protocol are not increased when compared to an earlier non-CTA based protocol. Methods: We evaluated a database of consecutive patients admitted to a Brazilian tertiary hospital with acute ischemic stroke from February 2009 to March 2014 and reviewed our stroke quality measures data to determine if the time required to obtain CTA prolonged door-to-neuroimaging, door to radiology report and door-to-needle times. Patients were categorized into: Group 1 (February 2009 to October 2013) (Non-contrast CT Scan based acute stroke protocol) and Group 2 (November 2013 to August 2014) (CTA based acute stroke protocol). Time intervals were compared between the two groups.Results: We evaluated 415 consecutive patients, 20 of whom (4.8%) had a CTA in the acute phase (Group 2). Patients in groups 1 and 2 had similar onset-to-door times (1.86 [0.75-3.58] versus 2.75 hours [1.0-8.49], p=0.09); door to neuroimaging times (27.6 [18.6-46.8] versus 37.8 minutes [23.4-46.2], p=0.28 ) and door to radiology report intervals (39 [27-60.6] versus 53.4 minutes[35.4-61.2], p=0.09). The frequency of treatment with recanalization therapies ( either intravenous thrombolysis or endovascular procedures) was similar between groups 1 (30%) and 2 (21%), p=0.33, as well as door to needle times (p=0.09). Conclusions: CTA based acute stroke care does not significantly delay time to neuroimaging or thrombolysis in routine clinical practice.

Abstract 331: Area Specific Differences for Quality of Care and Outcomes in Ischemic Stroke in China

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Meng Wang ◽  
Zi-Xiao Li ◽  
Chun-Juan Wang ◽  
Xin Yang ◽  
Yong-Jun Wang
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Hospital Death ◽  
Central Regions ◽  
Stroke Center ◽  
Care Improvement ◽  
Evidence Based Care

Background: Former studies suggest differences in stroke care associated with race, age or gender. We sought to find whether such disparities existed in different areas in patients hospitalized with stroke among hospitals participating in the China Stroke Center Association. Methods: In-hospital mortality and 4 stroke performance measures among 660,225 patients admitted with ischemic stroke in the Eastern, Central and Western regions of China in the China Stroke Center Association between 2015 and 2019. Results: After adjustment for both demographics and diseases history variables, western patients had lower odds relative of receiving intravenous thrombolysis (Eastern: OR, 1.78; 95%CI, 1.72 to 1.84; Central: OR, 1.55; 95%CI, 1.50 to 1.60), early antithrombotics (Eastern: OR, 1.95; 95%CI, 1.90 to 1.99; Central: OR, 1.86; 95%CI, 1.81 to 1.90), dysphagia screening (Eastern: OR, 1.03; 95%CI, 1.01 to 1.04; Central: OR, 0.83; 95%CI, 0.81 to 0.84) and NIHSS (Eastern: OR, 1.18; 95%CI, 1.16 to 1.20; Central: OR, 1.50; 95%CI, 1.48 to 1.53). However, the in-hospital death was higher in eastern and central regions (Eastern: OR, 0.48; 95%CI, 0.43 to 0.54; Central: OR, 0.51; 95%CI, 0.45 to 0.57). Conclusions: Western patients with stroke received fewer evidence-based care processes than central or eastern patients. Quality of care improvement in stroke should be focused on the west. The high mortality of the east and central probably resulted in that better hospitals in these areas received more severe patients substantially.

scholarly journals Pathway Design for Acute Stroke Care in the Era of Endovascular Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3452-3460 ◽  
Author(s):  
Willemijn J. Maas ◽  
Maarten M.H. Lahr ◽  
Erik Buskens ◽  
Durk-Jouke van der Zee ◽  
Maarten Uyttenboogaart ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Intravenous Thrombolysis ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Organizational Models ◽  
Acute Stroke Care ◽  
Endovascular Thrombectomy ◽  
Regular Treatment ◽  
Model Based ◽  
Comprehensive Stroke Center

The efficacy of intravenous thrombolysis and endovascular thrombectomy (EVT) for acute ischemic stroke is highly time dependent. Optimal organization of acute stroke care is therefore important to reduce treatment delays but has become more complex after the introduction of EVT as regular treatment for large vessel occlusions. There is no singular optimal organizational model that can be generalized to different geographic regions worldwide. Current dominant organizational models for EVT include the drip-and-ship- and mothership model. Guidelines recommend routing of suspected patients with stroke to the nearest intravenous thrombolysis capable facility; however, the choice of routing to a certain model should depend on regional stroke service organization and individual patient characteristics. In general, design approaches for organizing stroke care are required, in which 2 key strategies could be considered. The first entails the identification of interventions within existing organizational models for optimizing timely delivery of intravenous thrombolysis and/or EVT. This includes adaptive patient routing toward a comprehensive stroke center, which focuses particularly on prehospital triage tools; bringing intravenous thrombolysis or EVT to the location of the patient; and expediting services and processes along the stroke pathway. The second strategy is to develop analytical or simulation model-based approaches enabling the design and evaluation of organizational models before their implementation. Organizational models for acute stroke care need to take regional and patient characteristics into account and can most efficiently be assessed and optimized through the application of model-based approaches.

Referral patterns to palliative care: An inpatient snapshot study.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 119-119 ◽  
Author(s):  
Aaron Kee Yee Wong
Keyword(s):  
Palliative Care ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Referral Patterns ◽  
Early Integration ◽  
Medical Teams ◽  
Surgical Teams ◽  
Gold Standards

119 Background: Research suggests that palliative care referrals are not done as often or as early as required. In order to address potential barriers to referrals, current referral patterns need to be explored. We sought to identify the adequacy of palliative care referrals in hospital. Methods: We undertook a retrospective, cross-sectional study, censoring all inpatients on a single day from the largest tertiary hospital in the state. Each file was reviewed, and patients were identified as “palliative” based on the Gold Standards Framework criteria. Patients were followed for 3 months or until discharge, whichever was earlier. Results: Of the 873 inpatients, 134 patients were identified as palliative. Of the 95 patients who required formal palliative care input, only 28% were referred (27 patients). Specialty medical teams were the best at referring, whereas surgical teams were the worst. Only 50% of patients requiring terminal care and 10% requiring community palliative care (CPC) were referred. Conclusions: Alarmingly, most patients requiring palliative care were not referred (72% unreferred), most of these requiring CPC. Excluding CPC, still only 58% of patients requiring palliative care were referred. This is concerning, given data that shows that early integration of palliative care provides better quality of life, reduced depressive symptoms, and longer median survival. This suggests that either the severity of their illness is not recognised by treating teams, or that there is a lack of awareness in CPC, or possibly a lack of confidence in discussing it. There is a need for better referrals to palliative care, especially to CPC. Greater education is required, targeting the importance of early referrals. As used in this study, the Gold Standards Framework criteria can help identify patients who require referrals.

Challenges in Antenatal Corticosteroid Prescribing: A Retrospective Study

2020 ◽  
Vol 16 (4) ◽  
pp. 327-333
Author(s):  
Shannon Armstrong-Kempter ◽  
Lucinda Beech ◽  
Sarah J. Melov ◽  
Adrienne Kirby ◽  
Roshini Nayyar
Keyword(s):  
Retrospective Study ◽  
Obstetric Care ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Optimal Timing ◽  
Prescribing Practices ◽  
Antenatal Corticosteroids ◽  
Term Infants ◽  
Preterm Premature Rupture ◽  
To Receive

Background: The discovery of the benefits of antenatal corticosteroids (ACS) for preterm infants was one of the most significant developments in obstetric care. However, due to the difficulty in predicting preterm delivery, optimal use of ACS, is challenging. Objective: To describe prescribing practices for antenatal corticosteroids (ACS) at a tertiary hospital over five years to determine whether ACS were received at optimal timing; to determine patient characteristics of women receiving ACS at optimal timing; to determine patient characteristics of those who did not receive ACS as indicated and to examine the trend in ACS prescribing over the study period. Methods: We performed a retrospective study of all deliveries from January 2011 to December 2015. The rates of ACS prescription for each group of women (preterm, late preterm, and term) were recorded and analysed. Results: A total of 65% of women who delivered before 34 weeks’ gestation received ACS. Of these women, 63% delivered within 7 days of receiving ACS. Women most likely to receive ACS with optimal timing were primiparous (relative risk [RR], 1.25 [CI, 1.08-1.45]), or women diagnosed with pre-eclampsia (RR, 1.34 [CI 1.10-1.63]), preterm premature rupture of membranes (RR, 1.33 [CI, 1.15-1.54]) or threatened preterm labour (RR, 1.42 [CI, 1.22-1.65]). Conclusion: A significant number of women and babies are exposed to ACS without commensurate benefit, and a significant number who deliver preterm do not receive ACS. The percentage of preterm and term infants receiving ACS should be determined to optimise service delivery.

scholarly journals Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals

2019 ◽  
Vol 10 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Tristan B. Weir ◽  
Neil Sardesai ◽  
Julio J. Jauregui ◽  
Ehsan Jazini ◽  
Michael J. Sokolow ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Linear Regression Analysis ◽  
Degenerative Spondylolisthesis ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Community Hospitals ◽  
Single Level ◽  
Significant Difference ◽  
Reported Data

Study Design: Retrospective cohort study. Objective: As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. Methods: Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. Results: A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions ( P < .001) per level fused; the CH performed more interbody fusions ( P = .007). Cost of performing microdiscectomy ( P < .001) and laminectomy ( P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy ( P < .001) and laminectomy with single-level fusion ( P < .001), but trended toward significance for laminectomy without fusion ( P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH ( P = .019). Conclusions: We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

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