title: Acute stroke care at rural hospitals in Idaho: challenges in expediting stroke care.
abstract: BACKGROUND
  Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve.
  
  
  OBJECTIVE
  To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care.
  
  
  METHODS
  Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care.
  
  
  RESULTS
  The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed.
  
  
  CONCLUSIONS
  Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays.
authors.affiliation: Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Gebhardt
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Norris
mesh_terms: D002985:Clinical Protocols; D019091:Critical Pathways; D019538:Health Care Surveys; D006780:Hospitals, Rural / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007061:Idaho; D010348:Patient Care Team; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors