Across hospitals and health systems, stroke care sits at the intersection of several pressures leaders know well: rising acuity, uneven access to specialty care, workforce constraints and growing expectations around performance.
As those pressures intensify, the focus is no longer just on offering advanced stroke treatments, but on how rapidly teams can deliver them — especially for patients who require endovascular thrombectomy (EVT), a time-sensitive procedure used to remove large blood clots from the brain.
The American Heart Association’s Target: Stroke initiative has played a central role in helping hospitals improve the speed and consistency of acute stroke treatment. Earlier phases of the program focused on reducing the time from a patient’s arrival at the hospital to the administration of clot-busting medication, a benchmark that reshaped emergency stroke workflows nationwide.
Now, with the launch of Target: Stroke Phase III in 2017, the initiative has expanded to address a growing systems-level challenge: how to deliver EVT faster and how to move patients more efficiently between hospitals when advanced stroke care is not immediately available on site.
New research by the AHA offers clear evidence that these strategies are working — and clarifies which operational changes are most closely associated with faster treatment across different hospital settings.
What the data show
The study analyzed AHA Get With The Guidelines® – Stroke data from 1,305 U.S. hospitals between 2017 and 2022, examining patients across three common stroke-care scenarios:
- Patients arriving directly at thrombectomy-capable hospitals for EVT
- Patients transferred in from non-thrombectomy hospitals for EVT
- Patients treated initially at non-thrombectomy hospitals and transferred out for higher-level care
Baseline performance highlights the opportunity — and urgency — for improvement. Patients arriving directly at thrombectomy-capable hospitals had a median of nearly 107 minutes from hospital arrival to the start of the clot-removal procedure (often referred to as “door-to-puncture” time). Patients transferred in from another facility had a median of 53 minutes from arrival to the start of the procedure. Meanwhile, patients treated initially at non-thrombectomy hospitals had a median of more than two hours before departing for transfer (known as “door-in-door-out” time).
The study highlights how several Target: Stroke Phase III strategies were independently associated with faster treatment:
- Emergency medical services prenotification and advance alerts to the neurointerventional team were linked to a reduction of about 22 minutes from arrival to procedure start for patients arriving directly at thrombectomy-capable hospitals.
- Using an upfront CT scan + CT angiography protocol — performing both brain and vascular imaging early — reduced treatment times by roughly 7 minutes, helping teams identify thrombectomy candidates sooner.
- For transferred patients, greater use of video-based telestroke consultations made a meaningful difference: every 25% increase in video use shortened treatment times by nearly six minutes.
- At non-thrombectomy hospitals, integrated imaging and treatment workflows, including starting IV thrombolysis in the imaging suite, were associated with meaningful reductions in the time patients spent at the initial hospital before transfer. Telestroke network design factors were associated with larger time savings, in some cases in the range of 11–15 minutes.
Importantly, the impact of individual strategies varied by hospital type and care pathway, reinforcing that improvement efforts must be tailored to local capabilities and workflows.
From strategy to system
The implications of the research findings extend beyond stroke programs alone. They underscore a broader operational truth — that speed in complex care is rarely about a single “hero” or handoff. Rather, it is about coordination: aligning EMS, emergency departments, imaging, specialists and transfer partners around shared expectations and parallel workflows.
Early notification of specialty teams, for example, allows teams to prepare, adjust schedules and reduce downstream delays once imaging confirms the need for intervention. Similarly, embedding vascular imaging into the initial evaluation shifts decision-making upstream.
For hospitals that rely on transfers, video-enabled telestroke plays a critical role not only in clinical assessment, but in building trust and shared situational awareness between organizations — a theme increasingly visible across regionalized care models.
What this means for hospitals + health systems
For stroke program leaders, nurses, neurologists and quality teams, the takeaway is clear: incremental process improvements compound into meaningful time savings, and those minutes matter.
Just as importantly, many of the most effective strategies identified in the research are workflow-driven rather than capital-intensive. Clear protocols, EMS collaboration, standardized imaging pathways and intentional use of telehealth can often be implemented without major new investments, but they do require strong interdisciplinary alignment and leadership support.
Ultimately, faster treatment in stroke care is closely tied to better patient outcomes — and this research shows that targeted operational strategies can meaningfully improve speed.
To explore the full research findings and methodology, read the complete study here: Association of Component Strategies of the Target Stroke Phase 3 Nationwide Quality Improvement Program With Accelerated Door-to-Puncture and Door-In-Door-Out Times for Ischemic Stroke Endovascular Thrombectomy in the United States | Circulation: Cardiovascular Quality and Outcomes
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