title: Improving Access to Stroke Care in the Rural Setting: The Journey to Acute Stroke Ready Designation.
abstract: Stroke is the fifth highest cause of death and the leading cause of long-term disability in the United States. North Carolina has one of the highest death rates from stroke in the nation. Access to acute stroke care in rural western North Carolina is limited, with only one primary stroke center within an 18-county region. Angel Medical Center, located in rural western North Carolina, sought to pursue The Joint Commission's disease-specific certification as an Acute Stroke Ready Hospital in an effort to improve stroke care and outcomes across the region.
  
  
  METHODS
  A multidisciplinary team of ED clinicians, hospital leadership, and community participants was formed to develop a structured care algorithm and intensive process improvement initiatives to guide the Acute Stroke Ready Hospital application process.
  
  
  RESULTS
  In the 7 months since implementation, door-to-laboratory results have improved by an average of 12 minutes, door-to-computed tomography interpretation has improved by 3 minutes, time to intravenous thrombolytics has improved to less than 60 minutes, and patient transfer within 2 hours of arrival has also improved. ED provider average response time has been reduced by 5 minutes, and time to neurology via telemedicine has been reduced by almost 10 minutes.
  
  
  CONCLUSIONS
  By driving best practices in the delivery of stroke care, Angel Medical Center enhanced stroke care in a rural community, allowing patients and families to receive evaluation and treatment in a timely and efficient manner close to home.
authors.affiliation: Asheville, NC; Franklin, NC. Electronic address: andrea.slivinski@msj.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Slivinski
authors.affiliation: Asheville, NC; Franklin, NC.
authors.forename: Robin
authors.initials: R
authors.lastname: Jones
authors.affiliation: Asheville, NC; Franklin, NC.
authors.forename: Hollis
authors.initials: H
authors.lastname: Whitehead
authors.affiliation: Asheville, NC; Franklin, NC.
authors.forename: Vallire
authors.initials: V
authors.lastname: Hooper
mesh_terms: D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006780:Hospitals, Rural; D006801:Humans; D009657:North Carolina; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D017216:Telemedicine / Q000379:methods; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D005343:Fibrinolytic Agents