Across the country, rural facilities are rewriting the playbook on heart and stroke care — making bold and creative moves in limited resource environments. Through the American Heart Association’s Rural Health Care Outcomes Accelerator — a national initiative that connects rural hospitals with expert education, peer learning collaboratives and practical tools for improvement — rural hospitals are coming together to share uniquely developed strategies and solutions for meaningful innovation.
Through the no-cost Accelerator, a diverse group of rural hospitals across the nation is working together to tackle real challenges in heart and stroke care. With the support of the Heart Association’s quality improvement consultants, and access to practical, custom-tailored education materials, these health care professionals can implement data-driven, collaborative quality improvement strategies. Together, they are changing the trajectory of care for cardiovascular patients in rural communities across the nation.
Here are five standout strategies that exemplify real-world innovation in rural hospital settings from nearly 50 quality posters and model sharing presentations developed by Accelerator participants:
1. Bundled Imaging Protocols Reduce Critical Delays
Cox Barton County Hospital, in Missouri, revamped its stroke imaging workflow by bundling CT and CTA scans into a single protocol. This change, supported by staff training and protocol updates, led to dramatic improvements: door-in-door-out times dropped from 109 to 89 minutes, and door-to-CTA times were cut in half, from 75 minutes to just 37. With faster imaging and clearer decision-making, stroke patients now move through care more efficiently, increasing the likelihood of improved outcomes.
2. Stroke Simulations Improve Readiness
Quarterly mock stroke drills at Hendry Medical Center, in Florida, uncovered protocol gaps and sparked a transformation. By simulating real-world stroke scenarios, including EMS and tele-neurology coordination, the team identified where care could be faster, sharper and more consistent. The result: A 100% improvement in timely thrombolytic therapy, faster CT scans and better door-in-door-out times. Stroke readiness is no longer theoretical — it’s practiced.
3. Better Discharge Protocols Lower Readmissions
Meadville Medical Center, in Pennsylvania, tackled a common weak spot in heart failure care: delayed follow-up. They opened a dedicated outpatient heart failure clinic to accommodate appointments and deployed a population health team to support remote monitoring, medication management and education for patients. Through these efforts, the hospital achieved nearly 400% improvement in follow-up compliance. That operational tweak helped drive down 30-day readmission rates, keeping patients at home longer. A similar push at Beaufort Memorial Hospital, in South Carolina, used a multidisciplinary team to standardize discharge protocols and improve care transition coordination, boosting the hospital’s guideline-directed quadruple therapy medication at discharge adherence from 61% to 79%. This helped to reduce heart failure readmissions from 32% to 18%, saving an estimated $163,000 in potential penalties.
4. Stratification Tools Enhance Risk Prediction
Ashley Regional Medical Center, in Utah, embedded the HEART Score into its electronic health record to standardize cardiac risk assessments for chest pain and suspected acute coronary syndrome. As a result, 85% of applicable patients received a documented risk score. Among those identified as high risk, 71% received an anticoagulant before transfer, and 94% were transferred to another acute care hospital within six hours of arrival. The move toward structured risk stratification is helping the hospital prioritize care and act faster for patients who need it most.
5. Early Screening Efforts Boost Compliance
Early dysphagia screening is critical for preventing aspiration pneumonia and other complications related to stroke. Verde Valley Medical Center, in Arizona, improved dysphagia screening for stroke patients by adding screening prompts to its electronic health record, implementing targeted staff education and establishing stroke champions within the emergency department to advocate for best practices. The result: dysphagia screening compliance rates increased from 58% to 100%.
State-level strategies offer systemic insights
It’s not just individual hospitals making waves — statewide collaborations are reshaping rural cardiovascular care. Programs in Arkansas, North Dakota and South Carolina show how coordinated systems of care can deliver measurable results:
- North Dakota: Over a decade of participation in Get With The Guidelines® – Stroke led to dramatic improvements across North Dakota. From 2010 to 2023, rural hospitals saw a significant rise in stroke readiness, with the composite performance score increasing from 65% to 94.1% — reflecting broad gains across critical readiness measures like protocol adoption, staff training and quality improvement participation.
- South Carolina: Through a shared stroke care coordination model, the state health department receives stroke registry data from 53 hospitals across the state, of whom 14 are rural hospitals going the extra mile to intentionally measure and improve stroke care. Since 2018, rural hospital participation in Get With The Guidelines – Stroke has grown by more than 50%, and 13 rural hospitals have earned national stroke certification at the primary stroke center or acute stroke ready hospital level. These efforts continue to lay a strong foundation for measurable improvements.
- Arkansas: A statewide Heart Attack Quality Improvement focused on ST-elevation myocardial infarction (STEMI) care brought together rural hospitals, EMS and public health teams to streamline protocols. This resulted in the percentage of patients receiving a 12-lead ECG within 10 minutes increasing from 57.6% to 69.0%, and those receiving thrombolytics within 30 minutes rising from 46.7% to 55.8%. With 100% of non-PCI centers enrolled in Get With The Guidelines – Coronary Artery Disease now contributing data, the state is building a more coordinated and responsive system for rural heart attack care.
These rural hospitals and statewide collaboratives aren’t just innovating, they’re inspiring. With the support of the American Heart Association’s Rural Health Care Outcomes Accelerator, rural providers are flipping the script on what’s possible.
The message is clear: Innovation thrives in rural health care when it’s grounded in collaboration, continuous learning and evidence-based practice. And your hospital could be next — but enrollment in the Rural Health Care Outcomes Accelerator is only open until June 30. To sign up before this opportunity ends, visit heart.org/ruralaccelerator.
