Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association

Summary

This American Heart Association scientific statement provides a systematic framework for optimising the evaluation and management of in-hospital stroke. The authors identify that despite being in monitored hospital environments, in-hospital stroke patients experience longer treatment delays than those presenting to emergency departments, resulting in worse outcomes. The statement recommends five core elements—staff training, dedicated rapid response teams, standardised evaluation protocols, barrier reduction, and data-driven quality oversight—to improve care delivery and reduce stroke-related morbidity and mortality.

UK applicability

The clinical principles and systems-level recommendations are broadly applicable to UK hospital settings, though implementation would need to align with NHS organisational structures and stroke service pathways. UK hospitals may already have some elements in place through existing stroke centre networks and acute stroke protocols.

Key measures

Proposed quality improvement metrics for in-hospital stroke care systems; evaluation delays; morbidity and mortality rates

Outcomes reported

The statement identifies five core elements for optimising in-hospital stroke care, including staff training, rapid response teams, standardised evaluation protocols, treatment barrier mitigation, and quality oversight programmes. It notes that current delays in evaluation and treatment for in-hospital stroke patients contribute to higher morbidity and mortality compared with emergency department presentations.

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