Friday, February 25, 2022

Identifying Best Practices to Improve In-Hospital Stroke Management


The following are key points to remember from this American Heart Association (AHA) Scientific Statement about acute stroke management in patients with in-hospital stroke:

  1. Approximately 2-4% of patients with stroke have their event while hospitalized for another condition, with almost one half resulting from a vascular procedure.
  2. Suspected stroke symptoms can be confounded by medications, metabolic encephalopathy, and comorbid conditions.
  3. Time from symptom onset to stroke alert is delayed in in-hospital stroke.
  4. All hospital staff should be empowered to activate stroke alerts in the inpatient setting.
  5. Educating staff on the use of evidence-based rapid screening tools may improve accurate evaluation of patients suspected of in-hospital stroke.
  6. Patients with suspected in-hospital stroke require acute management in accordance with current AHA/American Stroke Association treatment guidelines.
  7. Hospitals unable to provide acute stroke treatment in the inpatient setting need to engage leadership, identify key barriers, and develop the appropriate pathways to facilitate and expedite necessary transfer to a higher level of care.
  8. Regional stroke systems of care should include protocols and algorithms for transfer and treatment of patients with in-hospital stroke from spoke to hub hospitals.
  9. Telemedicine should be considered for in-hospital stroke code evaluation when adequate, timely expertise is unavailable.
  10. Optimizing response time and health care resource stewardship and improving adherence to consensus quality measures are key areas of emphasis for quality improvement.


Nouh A, Amin-Hanjani S, Furie KL, et al.
Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association. Stroke 2022;Feb 9:[Epub ahead of print].
Twitter: @DrNabilPaktin 

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