Are acute stroke-ready hospitals ready?

I n 2005, an American Stroke Association Task Force report described the rationale and components of an integrated stroke system of care extending from primordial prevention through primary prevention, acute management, secondary prevention, and poststroke rehabilitation and recovery. 1 The principle that optimal patient outcomes depend on the consistent implementation of care processes that are based on the best available evidence and that are facilitated by key organizational features was implicit in the approach. 2 For acute stroke care, a 3-tiered system was envisioned composed of acute stroke–capable hospitals, having limited resources but possessing the means to deliver emergent stroke therapies; primary stroke center (PSC) hospitals, having the additional capacity to care for patients with stroke after the acute period; and comprehensive stroke center hospitals, having specialized resources and personnel to provide stroke treatment and rehabilitation that surpass those expected at PSCs.